Effectiveness of EDACS Versus ADAPT Accelerated Diagnostic Pathways for Chest Pain : A Pragmatic Randomized Controlled Trial Embedded Within Practice

Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved..

STUDY OBJECTIVE: A 2-hour accelerated diagnostic pathway based on the Thrombolysis in Myocardial Infarction score, ECG, and troponin measures (ADAPT-ADP) increased early discharge of patients with suspected acute myocardial infarction presenting to the emergency department compared with standard care (from 11% to 19.3%). Observational studies suggest that an accelerated diagnostic pathway using the Emergency Department Assessment of Chest Pain Score (EDACS-ADP) may further increase this proportion. This trial tests for the existence and size of any beneficial effect of using the EDACS-ADP in routine clinical care.

METHODS: This was a pragmatic randomized controlled trial of adults with suspected acute myocardial infarction, comparing the ADAPT-ADP and the EDACS-ADP. The primary outcome was the proportion of patients discharged to outpatient care within 6 hours of attendance, without subsequent major adverse cardiac event within 30 days.

RESULTS: Five hundred fifty-eight patients were recruited, 279 in each arm. Sixty-six patients (11.8%) had a major adverse cardiac event within 30 days (ADAPT-ADP 29; EDACS-ADP 37); 11.1% more patients (95% confidence interval 2.8% to 19.4%) were identified as low risk in EDACS-ADP (41.6%) than in ADAPT-ADP (30.5%). No low-risk patients had a major adverse cardiac event within 30 days (0.0% [0.0% to 1.9%]). There was no difference in the primary outcome of proportion discharged within 6 hours (EDACS-ADP 32.3%; ADAPT-ADP 34.4%; difference -2.1% [-10.3% to 6.0%], P=.65).

CONCLUSION: There was no difference in the proportion of patients discharged early despite more patients being classified as low risk by the EDACS-ADP than the ADAPT-ADP. Both accelerated diagnostic pathways are effective strategies for chest pain assessment and resulted in an increased rate of early discharges compared with previously reported rates.

Medienart:

E-Artikel

Erscheinungsjahr:

2016

Erschienen:

2016

Enthalten in:

Zur Gesamtaufnahme - volume:68

Enthalten in:

Annals of emergency medicine - 68(2016), 1 vom: 30. Juli, Seite 93-102.e1

Sprache:

Englisch

Beteiligte Personen:

Than, Martin P [VerfasserIn]
Pickering, John W [VerfasserIn]
Aldous, Sally J [VerfasserIn]
Cullen, Louise [VerfasserIn]
Frampton, Christopher M A [VerfasserIn]
Peacock, W Frank [VerfasserIn]
Jaffe, Allan S [VerfasserIn]
Goodacre, Steve W [VerfasserIn]
Richards, A Mark [VerfasserIn]
Ardagh, Michael W [VerfasserIn]
Deely, Joanne M [VerfasserIn]
Florkowski, Chris M [VerfasserIn]
George, Peter [VerfasserIn]
Hamilton, Gregory J [VerfasserIn]
Jardine, David L [VerfasserIn]
Troughton, Richard W [VerfasserIn]
van Wyk, Pieter [VerfasserIn]
Young, Joanna M [VerfasserIn]
Bannister, Laura [VerfasserIn]
Lord, Sally J [VerfasserIn]

Links:

Volltext

Themen:

Comparative Study
Journal Article
Pragmatic Clinical Trial
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Anmerkungen:

Date Completed 19.06.2017

Date Revised 21.08.2018

published: Print

ANZCTR: ACTRN12613000745741

Citation Status MEDLINE

doi:

10.1016/j.annemergmed.2016.01.001

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

NLM258148926