The Diagnostic Accuracy of the Emergency Department Assessment of Chest Pain (EDACS) Score: A Systematic Review and Meta-analysis

We evaluate current evidence for the diagnostic accuracy and safety of the Emergency Department Assessment of Chest Pain Score (EDACS) for patients presenting to the emergency department (ED) with possible acute coronary syndromes. MEDLINE, EMBASE, and Cochrane databases were searched for publications reporting data on the EDACS score. No date restrictions were used. Two independent researchers assessed studies for eligibility, bias, and quality. The primary outcome was major adverse cardiac events occurring within 30 days. Heterogeneity was assessed and data were pooled by meta-analysis using a random-effects model. Eight diagnostic test accuracy studies including 11,578 patients and 1 randomized controlled trial including 558 patients were eligible for inclusion. On meta-analysis, the EDACS score had a pooled sensitivity of 96.1% (95% confidence interval 89.6% to 98.6%) and specificity of 61.1% (95% confidence interval 55.5% to 66.3%). A total of 55.0% of patients (n=6,370/11,578) were identified as low risk and eligible for early discharge. Sixty-two patients (0.54%) identified as low risk had an outcome of major adverse cardiac events within 30 days. The EDACS score identified greater than 50% of patients with suspected acute coronary syndrome as suitable for discharge after serial troponin sampling during 2 hours. Sensitivity for major adverse cardiac events was relatively high overall and may be acceptable to clinicians.