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

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

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