JOMPAC
Journal of Medicine and Palliative Care

Journal of Medicine and Palliative Care (JOMPAC) is an open access scientific journal with independent, unbiased, and double-blind review under international guidelines. The purpose of JOMPAC is to contribute to the literature by publishing articles on health sciences and medicine.

eISSN: 2717-7505
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Submit Manuscript

Index
Original Article
Validation of the Emergency Department Assessment of Chest Pain Score and its accelerated diagnostic protocol in a Turkish cohort
Abstract
Aims: The Emergency Department Assessment of Chest Pain Score (EDACS) and its accelerated diagnostic protocol (EDACS-ADP) are widely used for risk stratification of chest pain patients. This study evaluated their diagnostic performance in a Turkish cohort.
Methods: This retrospective cross-sectional study analyzed patients presenting with chest pain to a Turkish Emergency Department (ED). Major adverse cardiac event (MACE) occurrence was determined through clinical follow-up and medical record review. The diagnostic accuracy of EDACS and EDACS-ADP in predicting MACE was evaluated.
Results: A total of 744 patients were included, with 94 (12.6%) in the MACE group and 650 (87.4%) in the no-MACE group. The median EDACS score was higher in the MACE group (20 [IQR 14-24] vs. 15 [IQR 9.75-20], p<0.001). EDACS sensitivity was 71.3% (95% CI 61.0-80.1), while EDACS-ADP achieved 100% (95% CI 96.2-100.0). Specificity was similar (EDACS: 52.3% [95% CI 48.4-56.2]; EDACS-ADP: 52.2% [95% CI 48.2-56.1]). EDACS-ADP had a higher positive likelihood ratio (PLR) (2.09 [95% CI 1.93-2.26] vs. 1.49 [95% CI 1.28-1.73]) and a lower negative likelihood ratio (NLR) (0 vs. 0.55 [95% CI 0.4-0.76]). Positive predictive value (PPV) was higher for EDACS-ADP (23.2% [95% CI 21.8-24.7]) than for EDACS (17.8% [95% CI 15.7-20.1]), while negative predictive value (NPV) was 100% for EDACS-ADP and 92.6% (95% CI 90.1-94.6) for EDACS.
Conclusion: EDACS effectively identified high-risk patients, while EDACS-ADP achieved 100% sensitivity and NPV, making it a reliable tool for safely discharging low-risk patients in a Turkish ED cohort.

Keywords : Chest pain, scores, adverse cardiac events, diagnostic performance, emergency department

Download Article


1. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the evaluation and diagnosis of chest pain: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;144(22):e336-e367. doi:10.1161/CIR.0000000000001030
2. Hsia RY, Hale Z, Tabas JA. A national study of the prevalence of life-threatening diagnoses in patients with chest pain. JAMA Intern Med. 2016;176(7):1029-1032. doi:10.1001/jamainternmed.2016.2498
3. Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139-e596. doi:10.1161/CIR.0000000000000757
4. Augustine L, Xavier F, Camille D, Mathilde Q. External validation of the SCARE score in identifying acute coronary syndromes during medical regulation of chest pain. BMC Emerg Med. 2025;25(1):20. doi:10.1186/s12873-025-01178-z
5. Shin YS, Ahn S, Kim YJ, Ryoo SM, Sohn CH, Kim WY. External validation of the emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP). Am J Emerg Med. 2020; 38(11):2264-2270. doi:10.1016/j.ajem.2019.09.019
6. Diercks DB, Kirk JD, Amsterdam EA. Chest pain units: management of special populations. Cardiol Clin. 2005;23(4):549-557,viii. doi:10.1016/j.ccl.2005.08.015
7. Amsterdam EA, Kirk JD, Bluemke DA, et al. Testing of low-risk patients presenting to the emergency department with chest pain. Circulation. 2010;122(17):1756-1776. doi:10.1161/CIR.0b013e3181ec61df
8. Stopyra JP, Miller CD, Hiestand BC, et al. Performance of the EDACS-accelerated diagnostic pathway in a cohort of US patients with acute chest pain. Crit Pathw Cardiol. 2015;14(4):134. doi:10.1097/HPC. 0000000000000059
9. Stopyra J, Snavely AC, Hiestand B, et al. Comparison of accelerated diagnostic pathways for acute chest pain risk stratification. Heart. 2020; 106(13):977-984. doi:10.1136/heartjnl-2019-316426
10. Than M, Flaws D, Sanders S, et al. Development and validation of the emergency department assessment of chest pain score and 2 h accelerated diagnostic protocol. Emerg Med Australas. 2014;26(1):34-44. doi:10.1111/1742-6723.12164
11. Stopyra JP, Riley RF, Hiestand BC, et al. The HEART pathway randomized controlled trial one-year outcomes. Acad Emerg Med. 2019; 26(1):41-50. doi:10.1111/acem.13504
12. Cullen L, Greenslade JH, Than M, et al. The new Vancouver chest pain rule using troponin as the only biomarker: an external validation study. Am J Emerg Med. 2014;32(2):129-134. doi:10.1016/j.ajem.2013.10.021
13. Than M, Cullen L, Aldous S, et al. 2-hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial. J Am Coll Cardiol. 2012;59(23):2091-2098. doi:10.1016/j.jacc.2012.02.035
14. Haasenritter J, Donner-Banzhoff N, Bösner S. Chest pain for coronary heart disease in general practice: clinical judgement and a clinical decision rule. Br J Gen Pract. 2015;65(640):e748-753. doi:10.3399/bjgp 15X687385
15. Fox KAA, Fitzgerald G, Puymirat E, et al. Should patients with acute coronary disease be stratified for management according to their risk? Derivation, external validation and outcomes using the updated GRACE risk score. BMJ Open. 2014;4(2):e004425. doi:10.1136/bmjopen- 2013-004425
16. Zaboli A, Ausserhofer D, Sibilio S, et al. Effect of the emergency department assessment of chest pain score on the triage performance in patients with chest pain. Am J Cardiol. 2021;161:12-18. doi:10.1016/j.amjcard.2021.08.058
17. Akbas I, Cakir Z, Kocak AO, et al. Clinical utility of EDACS-ADP in patients admitted with chest pain to an emergency department. Disaster Emerg Med J. 2021;6(1):33-40. doi:10.5603/DEMJ.a2021.0008
18. Than MP, Pickering JW, Aldous SJ, et al. Effectiveness of EDACS versus ADAPT accelerated diagnostic pathways for chest pain: a pragmatic randomized controlled trial embedded within practice. Ann Emerg Med. 2016;68(1):93-102.e1. doi:10.1016/j.annemergmed.2016.01.001
19. Wang M, Hu Z, Miao L, Shi M, Gao Q. A systematic review of the applicability of emergency department assessment of chest pain score-accelerated diagnostic protocol for risk stratification of patients with chest pain. Clin Cardiol. 2023;46(11):1303-1309. doi:10.1002/clc.24126
1. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the evaluation and diagnosis of chest pain: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;144(22):e336-e367. doi:10.1161/CIR.0000000000001030
2. Hsia RY, Hale Z, Tabas JA. A national study of the prevalence of life-threatening diagnoses in patients with chest pain. JAMA Intern Med. 2016;176(7):1029-1032. doi:10.1001/jamainternmed.2016.2498
3. Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139-e596. doi:10.1161/CIR.0000000000000757
4. Augustine L, Xavier F, Camille D, Mathilde Q. External validation of the SCARE score in identifying acute coronary syndromes during medical regulation of chest pain. BMC Emerg Med. 2025;25(1):20. doi:10.1186/s12873-025-01178-z
5. Shin YS, Ahn S, Kim YJ, Ryoo SM, Sohn CH, Kim WY. External validation of the emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP). Am J Emerg Med. 2020; 38(11):2264-2270. doi:10.1016/j.ajem.2019.09.019
6. Diercks DB, Kirk JD, Amsterdam EA. Chest pain units: management of special populations. Cardiol Clin. 2005;23(4):549-557,viii. doi:10.1016/j.ccl.2005.08.015
7. Amsterdam EA, Kirk JD, Bluemke DA, et al. Testing of low-risk patients presenting to the emergency department with chest pain. Circulation. 2010;122(17):1756-1776. doi:10.1161/CIR.0b013e3181ec61df
8. Stopyra JP, Miller CD, Hiestand BC, et al. Performance of the EDACS-accelerated diagnostic pathway in a cohort of US patients with acute chest pain. Crit Pathw Cardiol. 2015;14(4):134. doi:10.1097/HPC. 0000000000000059
9. Stopyra J, Snavely AC, Hiestand B, et al. Comparison of accelerated diagnostic pathways for acute chest pain risk stratification. Heart. 2020; 106(13):977-984. doi:10.1136/heartjnl-2019-316426
10. Than M, Flaws D, Sanders S, et al. Development and validation of the emergency department assessment of chest pain score and 2 h accelerated diagnostic protocol. Emerg Med Australas. 2014;26(1):34-44. doi:10.1111/1742-6723.12164
11. Stopyra JP, Riley RF, Hiestand BC, et al. The HEART pathway randomized controlled trial one-year outcomes. Acad Emerg Med. 2019; 26(1):41-50. doi:10.1111/acem.13504
12. Cullen L, Greenslade JH, Than M, et al. The new Vancouver chest pain rule using troponin as the only biomarker: an external validation study. Am J Emerg Med. 2014;32(2):129-134. doi:10.1016/j.ajem.2013.10.021
13. Than M, Cullen L, Aldous S, et al. 2-hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial. J Am Coll Cardiol. 2012;59(23):2091-2098. doi:10.1016/j.jacc.2012.02.035
14. Haasenritter J, Donner-Banzhoff N, Bösner S. Chest pain for coronary heart disease in general practice: clinical judgement and a clinical decision rule. Br J Gen Pract. 2015;65(640):e748-753. doi:10.3399/bjgp 15X687385
15. Fox KAA, Fitzgerald G, Puymirat E, et al. Should patients with acute coronary disease be stratified for management according to their risk? Derivation, external validation and outcomes using the updated GRACE risk score. BMJ Open. 2014;4(2):e004425. doi:10.1136/bmjopen- 2013-004425
16. Zaboli A, Ausserhofer D, Sibilio S, et al. Effect of the emergency department assessment of chest pain score on the triage performance in patients with chest pain. Am J Cardiol. 2021;161:12-18. doi:10.1016/j.amjcard.2021.08.058
17. Akbas I, Cakir Z, Kocak AO, et al. Clinical utility of EDACS-ADP in patients admitted with chest pain to an emergency department. Disaster Emerg Med J. 2021;6(1):33-40. doi:10.5603/DEMJ.a2021.0008
18. Than MP, Pickering JW, Aldous SJ, et al. Effectiveness of EDACS versus ADAPT accelerated diagnostic pathways for chest pain: a pragmatic randomized controlled trial embedded within practice. Ann Emerg Med. 2016;68(1):93-102.e1. doi:10.1016/j.annemergmed.2016.01.001
19. Wang M, Hu Z, Miao L, Shi M, Gao Q. A systematic review of the applicability of emergency department assessment of chest pain score-accelerated diagnostic protocol for risk stratification of patients with chest pain. Clin Cardiol. 2023;46(11):1303-1309. doi:10.1002/clc.24126
Article available in :
Volume 6, Issue 3, 2025
Page : 188-193
https://doi.org/10.47582/jompac.1641339
Article Information
Received : 17 Şub 2025
Accepted : 14 Nis 2025
Published : 18 Haz 2025
Corresponding Author :

Neslihan Ergün Süzer: Department of Emergency Medicine, Kocaeli Darıca Farabi Training and Research Hospital, Kocaeli, Turkiye

[email protected]
Citation : Ergün Süzer N, Tatliparmak AC. Validation of the Emergency Department Assessment of Chest Pain Score and its accelerated diagnostic protocol in a Turkish cohort. J Med Palliat Care. 2025;6(3):188-193. doi:10.47582/jompac.1641339

Read: 7
Cited: 0
Download : 3
_Footer