Acil servis göğüs ağrısı değerlendirme skoru ve hızlandırılmış tanı protokolünün Türk kohortunda geçerlilik çalışması

Year 2025, Volume: 6 Issue: 3, 188 - 193, 18.06.2025

Neslihan Ergün Süzer , Ali Cankut Tatliparmak

https://doi.org/10.47582/jompac.1641339

Abstract

Amaç: Acil Servis Göğüs Ağrısı Değerlendirme Skoru (ASGADS) ve Hızlandırılmış Tanı Protokolü (HTP), göğüs ağrısı hastalarının risk sınıflandırması için yaygın olarak kullanılmaktadır. Bu çalışma, ASGADS ve ASGADS-HTP’nin Türkiye kohortundaki tanısal performansını değerlendirmiştir.
Yöntemler: Bu retrospektif kesitsel çalışma, göğüs ağrısı ile acil servise başvuran hastaları analiz etmiştir. Majör kardiyak advers olay (MKAO) oluşumu, klinik takip ve tıbbi kayıt incelemesi yoluyla belirlenmiştir. ASGADS ve ASGADS-HTP’nin MKAO’yu öngörmedeki tanısal doğruluğu değerlendirilmiştir.
Bulgular: Çalışmaya toplam 744 hasta dahil edilmiş olup, bunlardan 94’ü (%12,6) MKAO grubunda ve 650’si (%87,4) MKAO olmayan grupta yer almıştır. MKAO grubunda medyan ASGADS skoru daha yüksekti (20 [IQR 14-24] vs. 15 [IQR 9,75-20], p<0,001). ASGADS’nin duyarlılığı %71,3 (95% CI 61,0-80,1) iken, ASGADS-HTP %100 (95% CI 96,2-100,0) duyarlılık sağladı. Her iki skor için özgüllük benzerdir (ASGADS: %52,3 [95% CI 48,4-56,2]; ASGADS-HTP: %52,2 [95% CI 48,2-56,1]). ASGADS-HTP'nin pozitif olasılık oranı (POO) daha yüksekti (2,09 [95% CI 1,93-2,26] vs. 1,49 [95% CI 1,28-1,73]), negatif olasılık oranı (NOO) ise daha düşüktü (0 vs. 0,55 [95% CI 0,4-0,76]). Pozitif prediktif değer (PPD) ASGADS-HTP için daha yüksekti (%23,2 [95% CI 21,8-24,7] vs. %17,8 [95% CI 15,7-20,1]), negatif prediktif değer (NPD) ise ASGADS-HTP için %100, ASGADS için %92,6 (95% CI 90,1-94,6) olarak bulundu.
Sonuç: ASGADS yüksek riskli hastaları etkili bir şekilde belirlerken, ASGADS-HTP %100 duyarlılık ve NPD sağlayarak düşük riskli hastaların güvenli taburculuğu için güvenilir bir araç olarak öne çıkmaktadır.

Keywords

göğüs ağrısı , skorlar , majör kardiyak advers olaylar , tanısal performans , acil servis

Validation of the Emergency Department Assessment of Chest Pain Score and its accelerated diagnostic protocol in a Turkish cohort

Abstract

Aims: The Emergency Department Assessment of Chest Pain Score (EDACS) and its accelerated diagnostic protocol (EDACS ADP) are widely used for risk stratification of chest pain patients. This study evaluated their diagnostic performance in a Turkish cohort.
Methods: This retrospective cross-sectional study analyzed patients presenting with chest pain to a Turkish Emergency Department (ED). Major adverse cardiac event (MACE) occurrence was determined through clinical follow-up and medical record review. The diagnostic accuracy of EDACS and EDACS-ADP in predicting MACE was evaluated.
Results: A total of 744 patients were included, with 94 (12.6%) in the MACE group and 650 (87.4%) in the no-MACE group. The median EDACS score was higher in the MACE group (20 [IQR 14-24] vs. 15 [IQR 9.75-20], p<0.001). EDACS sensitivity was 71.3% (95% CI 61.0-80.1), while EDACS-ADP achieved 100% (95% CI 96.2-100.0). Specificity was similar (EDACS: 52.3% [95% CI 48.4-56.2]; EDACS-ADP: 52.2% [95% CI 48.2-56.1]). EDACS-ADP had a higher positive likelihood ratio (PLR) (2.09 [95% CI 1.93-2.26] vs. 1.49 [95% CI 1.28-1.73]) and a lower negative likelihood ratio (NLR) (0 vs. 0.55 [95% CI 0.4-0.76]). Positive predictive value (PPV) was higher for EDACS-ADP (23.2% [95% CI 21.8-24.7]) than for EDACS (17.8% [95% CI 15.7-20.1]), while negative predictive value (NPV) was 100% for EDACS-ADP and 92.6% (95% CI 90.1-94.6) for EDACS.
Conclusion: EDACS effectively identified high-risk patients, while EDACS-ADP achieved 100% sensitivity and NPV, making it a reliable tool for safely discharging low-risk patients in a Turkish ED cohort.

Keywords

Chest pain , scores , adverse cardiac events , diagnostic performance , emergency department

References

• Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the evaluation and diagnosis of chest pain: executive summary: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;144(22):e336-e367. doi:10.1161/CIR.0000000000001030
• Hsia RY, Hale Z, Tabas JA. A national study of the prevalence of life-threatening diagnoses in patients with chest pain. JAMA Intern Med. 2016;176(7):1029-1032. doi:10.1001/jamainternmed.2016.2498
• Virani SS, Alonso A, Benjamin EJ, et al. Heart disease and stroke statistics-2020 update: a report from the American Heart Association. Circulation. 2020;141(9):e139-e596. doi:10.1161/CIR.0000000000000757
• Augustine L, Xavier F, Camille D, Mathilde Q. External validation of the SCARE score in identifying acute coronary syndromes during medical regulation of chest pain. BMC Emerg Med. 2025;25(1):20. doi:10.1186/s12873-025-01178-z
• Shin YS, Ahn S, Kim YJ, Ryoo SM, Sohn CH, Kim WY. External validation of the emergency department assessment of chest pain score accelerated diagnostic pathway (EDACS-ADP). Am J Emerg Med. 2020; 38(11):2264-2270. doi:10.1016/j.ajem.2019.09.019
• Diercks DB, Kirk JD, Amsterdam EA. Chest pain units: management of special populations. Cardiol Clin. 2005;23(4):549-557,viii. doi:10.1016/j.ccl.2005.08.015
• Amsterdam EA, Kirk JD, Bluemke DA, et al. Testing of low-risk patients presenting to the emergency department with chest pain. Circulation. 2010;122(17):1756-1776. doi:10.1161/CIR.0b013e3181ec61df
• Stopyra JP, Miller CD, Hiestand BC, et al. Performance of the EDACS-accelerated diagnostic pathway in a cohort of US patients with acute chest pain. Crit Pathw Cardiol. 2015;14(4):134. doi:10.1097/HPC. 0000000000000059
• Stopyra J, Snavely AC, Hiestand B, et al. Comparison of accelerated diagnostic pathways for acute chest pain risk stratification. Heart. 2020; 106(13):977-984. doi:10.1136/heartjnl-2019-316426
• Than M, Flaws D, Sanders S, et al. Development and validation of the emergency department assessment of chest pain score and 2 h accelerated diagnostic protocol. Emerg Med Australas. 2014;26(1):34-44. doi:10.1111/1742-6723.12164
• Stopyra JP, Riley RF, Hiestand BC, et al. The HEART pathway randomized controlled trial one-year outcomes. Acad Emerg Med. 2019; 26(1):41-50. doi:10.1111/acem.13504
• Cullen L, Greenslade JH, Than M, et al. The new Vancouver chest pain rule using troponin as the only biomarker: an external validation study. Am J Emerg Med. 2014;32(2):129-134. doi:10.1016/j.ajem.2013.10.021
• Than M, Cullen L, Aldous S, et al. 2-hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: the ADAPT trial. J Am Coll Cardiol. 2012;59(23):2091-2098. doi:10.1016/j.jacc.2012.02.035
• Haasenritter J, Donner-Banzhoff N, Bösner S. Chest pain for coronary heart disease in general practice: clinical judgement and a clinical decision rule. Br J Gen Pract. 2015;65(640):e748-753. doi:10.3399/bjgp 15X687385
• Fox KAA, Fitzgerald G, Puymirat E, et al. Should patients with acute coronary disease be stratified for management according to their risk? Derivation, external validation and outcomes using the updated GRACE risk score. BMJ Open. 2014;4(2):e004425. doi:10.1136/bmjopen- 2013-004425
• Zaboli A, Ausserhofer D, Sibilio S, et al. Effect of the emergency department assessment of chest pain score on the triage performance in patients with chest pain. Am J Cardiol. 2021;161:12-18. doi:10.1016/j.amjcard.2021.08.058
• Akbas I, Cakir Z, Kocak AO, et al. Clinical utility of EDACS-ADP in patients admitted with chest pain to an emergency department. Disaster Emerg Med J. 2021;6(1):33-40. doi:10.5603/DEMJ.a2021.0008
• Than MP, Pickering JW, Aldous SJ, et al. 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.e1. doi:10.1016/j.annemergmed.2016.01.001
• Wang M, Hu Z, Miao L, Shi M, Gao Q. A systematic review of the applicability of emergency department assessment of chest pain score-accelerated diagnostic protocol for risk stratification of patients with chest pain. Clin Cardiol. 2023;46(11):1303-1309. doi:10.1002/clc.24126