Retrospective analysis of the specificity and sensitivity of EDACS-ADP scoring in patients presenting to the emergency department with chest pain

Background-Aim: Chest pain is one of the most common reasons for applying to emergency services all over the world. The diagnosis of ACS is made by history, electrocardiography (ECG), and positive cardiac markers. However, being negative does not exclude the diagnosis of ACS. 2-5% of patients with ACS are improperly discharged from the emergency room each year. This situation leads to long follow-up and examination processes in the emergency services, thus causing both time and financial loss. For this reason, many ACS risk scoring systems have been developed. By identifying low-risk patients in a short time, they can be discharged faster, which results in a reduction in the intensity and financial losses in the emergency department. EDACS is an emergency medicine-based chest pain score derived from clinical data and was developed to identify patients deemed safe for early discharge. In our study, we aimed to evaluate the effectiveness of EDACS-ADP in detecting the risk of MICO. Material-Method: This study was carried out in Manisa Celal Bayar University, Faculty of Medicine, Department of Emergency Medicine. It is a cross-sectional and descriptive retrospective study. Patients who applied to the emergency department with chest pain between September 1, 2022 and November 1, 2022 and met the inclusion criteria were included in our study. The data were processed into the form prepared by the researcher in line with the relevant literature. Study data were collected retrospectively from the hospital database. Results: 58.2% (n=345) of the patients were male. The median age was 39.0(18.0-98.0) years. It was observed that 30.9% of the patients (n=183) had chronic disease. It was determined that a history of smoking was present in 23.1% (n=137) of the patients. Major cardiac events were detected in 10.5% of the patients during their 30-day follow-up. It was determined that 9.3% of the patients (n=55) were at high risk according to the EDACS-ADP risk scoring. The sensitivity of the EDACS-ADP score for MICO was 59.7%, specificity 96.6%, positive predictive value 67.3%, negative predictive value 95.4%. When the characteristics of patients who developed MICO were evaluated, it was determined that there was a statistically significant relationship between age, presence of chronic disease, smoking and MICO development. In accordance with the literature, troponin positivity and abnormal ECG findings were significantly higher in patients who developed MICO than those who did not. According to the results of our study, EDACS and EDACS-ADP risk scoring were found to have low sensitivity, high specificity, low positive predictive values, and high negative predictive values. In our study, MICO development rate was found to be 34.9% in hospitalized patients and 5.0% in discharged patients, and it was found to be significantly higher in hospitalized patients. Conclusion: We think that the low mean age in the sample of the study expanded the group that EDACS-ADP determined as low risk, decreased the sensitivity and increased the specificity. Although there are many studies reporting that the sensitivity and negative predictive value of EDACS-ADP in the low-risk group are high and its clinical use is appropriate, we did not find the same efficacy in our study. We think that the differences with the international studies may be due to the differences in the emergency triage method and revascularization procedure between countries. Different triage methods may have limited the patient groups included, and revascularization methods may have caused changes in MICO rates. Key words: acute coronary syndrome, chest pain, EDACS, EDACS-ADP