EDACS Score Calculator

About Emergency Department Assessment of Chest Pain Score

EDACS is a chest pain decision aid tool that can specifically identify patients with low risk of acute coronary syndrome (ACS) or major adverse cardiac event (MACE). EDACS may be used in the emergency departments in triage in an decision making about early discharge of low risk patients.

MACE is defined as any of the following:

• ST-elevation or non-ST-elevation MI.
• Need for emergency revascularization
• Ventricular arrhythmia
• Cardiogenic shock
• Cardiac arrest
• High atrio-ventricular block
• Death of cardiovascular etiology.

During the original study, a low-risk group of patients (approximately 45% from cohort with 99-199% sensitivity) were identified as safe to be discharged from emergency department after two blood biomarkers (0 and 2-hr troponin testing), EKG, patient history and physical examination, pending close follow-up in a primary care setting. However, other causes of chest pain should be explored prior to discharge.

Patients who do not meet the low-risk criteria (with EDACS score of 16 or more or EKG positive of ischemia or positive troponin) should undergo serial EKG and biomarker testing and the diagnostic protocols should be followed.

The following table introduces the variable used in the EDACS to rule-out or in the low-risk group:

The low-risk group is identified as EDACS

In the EDACS study cohort, the score correctly identified 45% of patients as low-risk, with higher rates than similar decision aids such as the HEART score, Vancouver Chest Pain Score or GRACE score.

A comparison between EDACS-ADP (with accelerated diagnostic protocol, i.e. use of EKG and biomarkers) and the ADAPT-ADP found that the EDACS identified a higher proportion of low-risk patients (41.6% vs. 30.5%) with both groups having a NPV of 100%. But the primary outcome of the proportion of patients safely discharged within 6 hours was the similar between the two scores (32.3% vs. 34.4% respectively).

Another comparison of EDACS with the HEARTS score, on a retrospective study of 118,822 patients with data collected over 3 years found that whilst both scores correctly identified low-risk 60-day MACE, the EDACS predicted a larger proportion, 60.8% compared to 51.8%.

References

Original reference

Than M, et al. Emerg Med Australas. Development and validation of the Emergency Department Assessment of Chest pain Score and 2 h accelerated diagnostic protocol. 2014; 26(1):34-44.

Validation

Than MP, Pickering JW, Aldous SJ, Cullen L, Frampton CM, Peacock WF, Jaffe AS, Goodacre SW, Richards AM, Ardagh MW, Deely JM, Florkowski CM, George P, Hamilton GJ, Jardine DL, Troughton RW, van Wyk P, Young JM, Bannister L, Lord SJ. 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

Flaws D, Than M, Scheuermeyer FX, Christenson J, Boychuk B, Greenslade JH, Aldous S, Hammett CJ, Parsonage WA, Deely JM, Pickering JW, Cullen L. External validation of the emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP). Emerg Med J. 2016; 33(9):618-25

Mark DG, Huang J, Chettipally U, Kene MV, Anderson ML, Hess EP, Ballard DW, Vinson DR, Reed ME; Kaiser Permanente CREST Network Investigators. Performance of Coronary Risk Scores Among Patients With Chest Pain in the Emergency Department. J Am Coll Cardiol. 2018; 71(6):606-616

Boyle RSJ, Body R. The diagnostic accuracy of the emergency department assessment of chest pain (Edacs) score: a systematic review and meta-analysis. Ann Emerg Med. 2021; 77(4):433-441.