This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Chest pain is one of the most common reasons to come to an emergency department, and most patients do not have an acute coronary syndrome. The Emergency Department Assessment of Chest pain Score (EDACS), developed in New Zealand and Australia by Than and colleagues in 2014, helps identify patients who can safely go home early. Combined with an ECG and troponins at 0 and 2 hours, it forms the EDACS accelerated diagnostic protocol (EDACS-ADP).
The points
| Item | Points |
|---|---|
| Age 18 to 45 | 2 |
| Each 5 years from 46 to 85 | +2 (4 at 46 to 50 up to 18 at 81 to 85) |
| Age 86 or older | 20 |
| Male sex | 6 |
| Age 18 to 50 with known coronary disease or 3 or more risk factors | 4 |
| Diaphoresis | 3 |
| Pain radiating to the arm, shoulder, neck or jaw | 5 |
| Pain occurred or worsened with inspiration | -4 |
| Pain reproduced by palpation | -6 |
Risk factors are a family history of early coronary disease, dyslipidemia, diabetes, hypertension and current smoking. Pleuritic and reproducible pain lower the score because they point away from the heart.
Example
A 52-year-old man (6 for age, 6 for sex) whose pain radiates to the left arm (5) scores 17: not low risk, whatever the troponin shows. Had the pain been reproduced by pressing on his chest instead of radiating, he would score 6: low risk if his ECG and troponins were normal.
The EDACS-ADP
A patient is low risk when all three conditions hold:
- EDACS under 16
- no new ischemia on the ECG
- troponin at 0 and 2 hours below the cutoff
In validation studies, fewer than 1% of low-risk patients had a major adverse cardiac event within 30 days, and up to half of chest pain patients could be classified as low risk.
How it compares
The HEART score is more widely used in Europe and the United States and needs a clinician’s judgment of the history. EDACS uses objective items only. Both work best with high-sensitivity troponin protocols.
Limits
EDACS does not apply to patients with ST elevation, unstable vital signs or an obvious other cause of pain. Low risk does not mean no risk: patients should get follow-up and clear advice to return if symptoms recur.