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 |
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Erscheinungsjahr: |
2016 |
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Erschienen: |
2016 |
Enthalten in: |
Zur Gesamtaufnahme - volume:68 |
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Enthalten in: |
Annals of emergency medicine - 68(2016), 1 vom: 30. Juli, Seite 93-102.e1 |
Sprache: |
Englisch |
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Beteiligte Personen: |
Than, Martin P [VerfasserIn] |
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Links: |
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Themen: |
Comparative Study |
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Anmerkungen: |
Date Completed 19.06.2017 Date Revised 21.08.2018 published: Print ANZCTR: ACTRN12613000745741 Citation Status MEDLINE |
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doi: |
10.1016/j.annemergmed.2016.01.001 |
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funding: |
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Förderinstitution / Projekttitel: |
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PPN (Katalog-ID): |
NLM258148926 |
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245 | 1 | 0 | |a Effectiveness of EDACS Versus ADAPT Accelerated Diagnostic Pathways for Chest Pain |b A Pragmatic Randomized Controlled Trial Embedded Within Practice |
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500 | |a Date Revised 21.08.2018 | ||
500 | |a published: Print | ||
500 | |a ANZCTR: ACTRN12613000745741 | ||
500 | |a Citation Status MEDLINE | ||
520 | |a Copyright © 2016 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved. | ||
520 | |a 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 | ||
520 | |a 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 | ||
520 | |a 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) | ||
520 | |a 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 | ||
650 | 4 | |a Comparative Study | |
650 | 4 | |a Journal Article | |
650 | 4 | |a Pragmatic Clinical Trial | |
650 | 4 | |a Randomized Controlled Trial | |
650 | 4 | |a Research Support, Non-U.S. Gov't | |
700 | 1 | |a Pickering, John W |e verfasserin |4 aut | |
700 | 1 | |a Aldous, Sally J |e verfasserin |4 aut | |
700 | 1 | |a Cullen, Louise |e verfasserin |4 aut | |
700 | 1 | |a Frampton, Christopher M A |e verfasserin |4 aut | |
700 | 1 | |a Peacock, W Frank |e verfasserin |4 aut | |
700 | 1 | |a Jaffe, Allan S |e verfasserin |4 aut | |
700 | 1 | |a Goodacre, Steve W |e verfasserin |4 aut | |
700 | 1 | |a Richards, A Mark |e verfasserin |4 aut | |
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700 | 1 | |a Deely, Joanne M |e verfasserin |4 aut | |
700 | 1 | |a Florkowski, Chris M |e verfasserin |4 aut | |
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700 | 1 | |a Hamilton, Gregory J |e verfasserin |4 aut | |
700 | 1 | |a Jardine, David L |e verfasserin |4 aut | |
700 | 1 | |a Troughton, Richard W |e verfasserin |4 aut | |
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700 | 1 | |a Young, Joanna M |e verfasserin |4 aut | |
700 | 1 | |a Bannister, Laura |e verfasserin |4 aut | |
700 | 1 | |a Lord, Sally J |e verfasserin |4 aut | |
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