cliot (version 1.0.0)

edacs_chest_pain_score: Emergency Department Assessment of Chest Pain Score (EDACS)

Description

Calculates the EDACS Score to identify chest pain patients with a low risk of Major Adverse Cardiac Events (MACE) who may be safe for early discharge. The full EDACS-ADP (Accelerated Diagnostic Protocol) incorporates the score (< 16), lack of new ischemia on EKG, and negative troponin measurements at 0 and 2 hours.

Usage

edacs_chest_pain_score(age, sex, known_cad_or_3_risk_factors, diaphoresis,
                       radiation, pain_inspiration, pain_palpation,
                       ekg_ischemia_present = FALSE, troponin_normal = TRUE)

Value

A list containing:

EDACS_Score

The calculated score (Range -10 to +50 range possible depending on inputs).

Risk_Category

"Low Risk" if Score < 16 AND no EKG ischemia AND normal troponins; otherwise "Not Low Risk".

Recommendation

Guidance on discharge vs. observation.

Arguments

age

Numeric. Patient age in years (must be >= 18).

sex

String. Patient sex ("Male" or "Female"). Male sex adds +6 points.

known_cad_or_3_risk_factors

Numeric (0 or 1). Does the patient have known Coronary Artery Disease (CAD) OR >= 3 risk factors (Age 45-65M/55-65F, Dyslipidemia, Diabetes, Hypertension, Current Smoker, Family History)? (1 = Yes, +4 points).

diaphoresis

Numeric (0 or 1). Presence of diaphoresis. (1 = Yes, +3 points).

radiation

Numeric (0 or 1). Pain radiates to arm, shoulder, neck, or jaw. (1 = Yes, +5 points).

pain_inspiration

Numeric (0 or 1). Pain occurs or worsens with inspiration. (1 = Yes, -4 points).

pain_palpation

Numeric (0 or 1). Pain is reproduced by palpation. (1 = Yes, -6 points).

ekg_ischemia_present

Numeric (0 or 1). New ischemia on ECG. (1 = Yes). Required for full protocol assessment.

troponin_normal

Numeric (0 or 1). Are 0h and 2h troponin levels negative? (1 = Yes). Required for full protocol assessment.

References

Than M, Flaws D, Sanders S, et al. Development and validation of the Emergency Department Assessment of Chest pain Score and 2h accelerated diagnostic protocol. Emerg Med Australas. 2014;26(1):34-44. doi:10.1111/1742-6723.12164

Examples

# Example 1: Low Risk Patient
# 40yo Female (2), No Hx (0), No Diaphoresis (0), No Radiation (0),
# Pain with Inspiration (-4), Palpation (-6) -> Score = -8
# Normal EKG, Normal Troponin
edacs_chest_pain_score(40, "female", 0, 0, 0, 1, 1, 0, 1)

# Example 2: High Risk Patient
# 65yo Male (10+6=16), Known CAD (+4), Diaphoresis (+3) -> Score = 23
edacs_chest_pain_score(65, "male", 1, 1, 0, 0, 0, 0, 1)