BACKGROUND:The accelerated diagnostic protocol(ADP)using the Emergency Department Assessment of Chest pain Score(EDACS-ADP),a tool to identify patients at low risk of a major adverse cardiac event(MACE)among patients presenting with chest pain to the emergency department,was developed using a contemporary troponin assay.This study was performed to validate and compare the performance of the EDACS-ADP incorporating high-sensitivity cardiac troponin I between patients who had a 30-day MACE with and without unstable angina(MACE I and Ⅱ,respectively). METHODS:A single-center prospective observational study of adult patients presenting with chest pain suggestive of acute coronary syndrome was performed.The performance of EDACS-ADP in predicting MACE was assessed by calculating the sensitivity and negative predictive value. RESULTS:Of the 1,304 patients prospectively enrolled,399(30.6％;95％confidence interval[95％CI]:27.7％-33.8％)were considered low-risk using the EDACS-ADP.Among them,the rates of MACE I andⅡ were 1.3％(5/399)and 1.0％(4/399),respectively.The EDACS-ADP showed sensitivities and negative predictive values of 98.8％(95％CI:97.2％-99.6％)and 98.7％(95％CI:97.0％-99.5％)for MACE I and 98.7％(95％CI:96.8％-99.7％)and 99.0％(95％CI:97.4％-99.6％)for MACE Ⅱ,respectively. CONCLUSION:EDACS-ADP could help identify patients as safe for early discharge.However,when unstable angina was added to the outcome,the 30-day MACE rate among the designated low-risk patients remained above the level acceptable for early discharge without further evaluation.

BACKGROUND:The accelerated diagnostic protocol(ADP)using the Emergency Department Assessment of Chest pain Score(EDACS-ADP),a tool to identify patients at low risk of a major adverse cardiac event(MACE)among patients presenting with chest pain to the emergency department,was developed using a contemporary troponin assay.This study was performed to validate and compare the performance of the EDACS-ADP incorporating high-sensitivity cardiac troponin I between patients who had a 30-day MACE with and without unstable angina(MACE I and Ⅱ,respectively). METHODS:A single-center prospective observational study of adult patients presenting with chest pain suggestive of acute coronary syndrome was performed.The performance of EDACS-ADP in predicting MACE was assessed by calculating the sensitivity and negative predictive value. RESULTS:Of the 1,304 patients prospectively enrolled,399(30.6％;95％confidence interval[95％CI]:27.7％-33.8％)were considered low-risk using the EDACS-ADP.Among them,the rates of MACE I andⅡ were 1.3％(5/399)and 1.0％(4/399),respectively.The EDACS-ADP showed sensitivities and negative predictive values of 98.8％(95％CI:97.2％-99.6％)and 98.7％(95％CI:97.0％-99.5％)for MACE I and 98.7％(95％CI:96.8％-99.7％)and 99.0％(95％CI:97.4％-99.6％)for MACE Ⅱ,respectively. CONCLUSION:EDACS-ADP could help identify patients as safe for early discharge.However,when unstable angina was added to the outcome,the 30-day MACE rate among the designated low-risk patients remained above the level acceptable for early discharge without further evaluation.

BACKGROUND:The accelerated diagnostic protocol(ADP)using the Emergency Department Assessment of Chest pain Score(EDACS-ADP),a tool to identify patients at low risk of a major adverse cardiac event(MACE)among patients presenting with chest pain to the emergency department,was developed using a contemporary troponin assay.This study was performed to validate and compare the performance of the EDACS-ADP incorporating high-sensitivity cardiac troponin I between patients who had a 30-day MACE with and without unstable angina(MACE I and Ⅱ,respectively). METHODS:A single-center prospective observational study of adult patients presenting with chest pain suggestive of acute coronary syndrome was performed.The performance of EDACS-ADP in predicting MACE was assessed by calculating the sensitivity and negative predictive value. RESULTS:Of the 1,304 patients prospectively enrolled,399(30.6％;95％confidence interval[95％CI]:27.7％-33.8％)were considered low-risk using the EDACS-ADP.Among them,the rates of MACE I andⅡ were 1.3％(5/399)and 1.0％(4/399),respectively.The EDACS-ADP showed sensitivities and negative predictive values of 98.8％(95％CI:97.2％-99.6％)and 98.7％(95％CI:97.0％-99.5％)for MACE I and 98.7％(95％CI:96.8％-99.7％)and 99.0％(95％CI:97.4％-99.6％)for MACE Ⅱ,respectively. CONCLUSION:EDACS-ADP could help identify patients as safe for early discharge.However,when unstable angina was added to the outcome,the 30-day MACE rate among the designated low-risk patients remained above the level acceptable for early discharge without further evaluation.

BACKGROUND:The accelerated diagnostic protocol(ADP)using the Emergency Department Assessment of Chest pain Score(EDACS-ADP),a tool to identify patients at low risk of a major adverse cardiac event(MACE)among patients presenting with chest pain to the emergency department,was developed using a contemporary troponin assay.This study was performed to validate and compare the performance of the EDACS-ADP incorporating high-sensitivity cardiac troponin I between patients who had a 30-day MACE with and without unstable angina(MACE I and Ⅱ,respectively). METHODS:A single-center prospective observational study of adult patients presenting with chest pain suggestive of acute coronary syndrome was performed.The performance of EDACS-ADP in predicting MACE was assessed by calculating the sensitivity and negative predictive value. RESULTS:Of the 1,304 patients prospectively enrolled,399(30.6％;95％confidence interval[95％CI]:27.7％-33.8％)were considered low-risk using the EDACS-ADP.Among them,the rates of MACE I andⅡ were 1.3％(5/399)and 1.0％(4/399),respectively.The EDACS-ADP showed sensitivities and negative predictive values of 98.8％(95％CI:97.2％-99.6％)and 98.7％(95％CI:97.0％-99.5％)for MACE I and 98.7％(95％CI:96.8％-99.7％)and 99.0％(95％CI:97.4％-99.6％)for MACE Ⅱ,respectively. CONCLUSION:EDACS-ADP could help identify patients as safe for early discharge.However,when unstable angina was added to the outcome,the 30-day MACE rate among the designated low-risk patients remained above the level acceptable for early discharge without further evaluation.

BACKGROUND:The accelerated diagnostic protocol(ADP)using the Emergency Department Assessment of Chest pain Score(EDACS-ADP),a tool to identify patients at low risk of a major adverse cardiac event(MACE)among patients presenting with chest pain to the emergency department,was developed using a contemporary troponin assay.This study was performed to validate and compare the performance of the EDACS-ADP incorporating high-sensitivity cardiac troponin I between patients who had a 30-day MACE with and without unstable angina(MACE I and Ⅱ,respectively). METHODS:A single-center prospective observational study of adult patients presenting with chest pain suggestive of acute coronary syndrome was performed.The performance of EDACS-ADP in predicting MACE was assessed by calculating the sensitivity and negative predictive value. RESULTS:Of the 1,304 patients prospectively enrolled,399(30.6％;95％confidence interval[95％CI]:27.7％-33.8％)were considered low-risk using the EDACS-ADP.Among them,the rates of MACE I andⅡ were 1.3％(5/399)and 1.0％(4/399),respectively.The EDACS-ADP showed sensitivities and negative predictive values of 98.8％(95％CI:97.2％-99.6％)and 98.7％(95％CI:97.0％-99.5％)for MACE I and 98.7％(95％CI:96.8％-99.7％)and 99.0％(95％CI:97.4％-99.6％)for MACE Ⅱ,respectively. CONCLUSION:EDACS-ADP could help identify patients as safe for early discharge.However,when unstable angina was added to the outcome,the 30-day MACE rate among the designated low-risk patients remained above the level acceptable for early discharge without further evaluation.

BACKGROUND:The accelerated diagnostic protocol(ADP)using the Emergency Department Assessment of Chest pain Score(EDACS-ADP),a tool to identify patients at low risk of a major adverse cardiac event(MACE)among patients presenting with chest pain to the emergency department,was developed using a contemporary troponin assay.This study was performed to validate and compare the performance of the EDACS-ADP incorporating high-sensitivity cardiac troponin I between patients who had a 30-day MACE with and without unstable angina(MACE I and Ⅱ,respectively). METHODS:A single-center prospective observational study of adult patients presenting with chest pain suggestive of acute coronary syndrome was performed.The performance of EDACS-ADP in predicting MACE was assessed by calculating the sensitivity and negative predictive value. RESULTS:Of the 1,304 patients prospectively enrolled,399(30.6％;95％confidence interval[95％CI]:27.7％-33.8％)were considered low-risk using the EDACS-ADP.Among them,the rates of MACE I andⅡ were 1.3％(5/399)and 1.0％(4/399),respectively.The EDACS-ADP showed sensitivities and negative predictive values of 98.8％(95％CI:97.2％-99.6％)and 98.7％(95％CI:97.0％-99.5％)for MACE I and 98.7％(95％CI:96.8％-99.7％)and 99.0％(95％CI:97.4％-99.6％)for MACE Ⅱ,respectively. CONCLUSION:EDACS-ADP could help identify patients as safe for early discharge.However,when unstable angina was added to the outcome,the 30-day MACE rate among the designated low-risk patients remained above the level acceptable for early discharge without further evaluation.

BACKGROUND:The accelerated diagnostic protocol(ADP)using the Emergency Department Assessment of Chest pain Score(EDACS-ADP),a tool to identify patients at low risk of a major adverse cardiac event(MACE)among patients presenting with chest pain to the emergency department,was developed using a contemporary troponin assay.This study was performed to validate and compare the performance of the EDACS-ADP incorporating high-sensitivity cardiac troponin I between patients who had a 30-day MACE with and without unstable angina(MACE I and Ⅱ,respectively). METHODS:A single-center prospective observational study of adult patients presenting with chest pain suggestive of acute coronary syndrome was performed.The performance of EDACS-ADP in predicting MACE was assessed by calculating the sensitivity and negative predictive value. RESULTS:Of the 1,304 patients prospectively enrolled,399(30.6％;95％confidence interval[95％CI]:27.7％-33.8％)were considered low-risk using the EDACS-ADP.Among them,the rates of MACE I andⅡ were 1.3％(5/399)and 1.0％(4/399),respectively.The EDACS-ADP showed sensitivities and negative predictive values of 98.8％(95％CI:97.2％-99.6％)and 98.7％(95％CI:97.0％-99.5％)for MACE I and 98.7％(95％CI:96.8％-99.7％)and 99.0％(95％CI:97.4％-99.6％)for MACE Ⅱ,respectively. CONCLUSION:EDACS-ADP could help identify patients as safe for early discharge.However,when unstable angina was added to the outcome,the 30-day MACE rate among the designated low-risk patients remained above the level acceptable for early discharge without further evaluation.

BACKGROUND:The accelerated diagnostic protocol(ADP)using the Emergency Department Assessment of Chest pain Score(EDACS-ADP),a tool to identify patients at low risk of a major adverse cardiac event(MACE)among patients presenting with chest pain to the emergency department,was developed using a contemporary troponin assay.This study was performed to validate and compare the performance of the EDACS-ADP incorporating high-sensitivity cardiac troponin I between patients who had a 30-day MACE with and without unstable angina(MACE I and Ⅱ,respectively). METHODS:A single-center prospective observational study of adult patients presenting with chest pain suggestive of acute coronary syndrome was performed.The performance of EDACS-ADP in predicting MACE was assessed by calculating the sensitivity and negative predictive value. RESULTS:Of the 1,304 patients prospectively enrolled,399(30.6％;95％confidence interval[95％CI]:27.7％-33.8％)were considered low-risk using the EDACS-ADP.Among them,the rates of MACE I andⅡ were 1.3％(5/399)and 1.0％(4/399),respectively.The EDACS-ADP showed sensitivities and negative predictive values of 98.8％(95％CI:97.2％-99.6％)and 98.7％(95％CI:97.0％-99.5％)for MACE I and 98.7％(95％CI:96.8％-99.7％)and 99.0％(95％CI:97.4％-99.6％)for MACE Ⅱ,respectively. CONCLUSION:EDACS-ADP could help identify patients as safe for early discharge.However,when unstable angina was added to the outcome,the 30-day MACE rate among the designated low-risk patients remained above the level acceptable for early discharge without further evaluation.

Objective: Emergency medical system reform is an important part of the 4th Emergency Medical Care 5-year plan in Korea, published in 2023. However, little is known about the current emergency department (ED) utilization status of local emergency medical agencies (EMAs). We sought to compare the ED utilization code between the emergency medical centers (EMCs) (n=58) and the local EMAs (n=152) based on parameters such as the admission rate or transfer rate in patients with a critical illness. Methods: Consecutive emergency patients registered on the National Emergency Department Information System from January 2022 to December 2022 were included in this study and their records were analyzed. The study included critically ill patients who were defined as having a critical illness code. Results: Among 590,878 (EMC of 450,007; local EMA of 140,871) critical illness code patients, the admission rate was 76.2% for EMCs and 52.9% for local EMAs. Of the critical illness code patients who visited local EMAs, 89.4% were Korean Triage and Acuity Scale (KTAS) grade 3-5 patients. The hospitalization volume of critical illness code patients in the local EMAs was 74,571, mostly major trauma (47.5%) and ischemic stroke (11.5%). If KTAS grade 1 or 2 patients could not be transferred to the local EMAs, the EMCs covered up to 14,989 ED patients and 74,571 admitted patients additionally. Conclusion If the local EMAs maintain their current roles in the areas of major trauma and ischemic stroke, and take charge of the admission of patients with critical illness codes transferred from the EMC after emergency treatment, then the local EMAs can still maintain their functions even after the proposed emergency medical system reform.

Objective: This study examined the difference in procalcitonin between sepsis and septic shock. Methods: The single-center retrospective cohort study was conducted from July 2017 to June 2018 at an emergency department (ED) of a university hospital. The inclusion criteria were patients over 18 years old who visited the ED with an infection. The exclusion criteria were the patients without organ failure by sepsis-3 definition, those with missing serum lactate data, and those discharged without workup. The sepsis patients were divided into those with and without septic shock, and the two groups were compared with biomarkers, including procalcitonin. Results: Of the 406 patients who visited the ED with an infection, 36 were excluded because they did not have sepsis or an unknown infection. Finally, 369 patients were enrolled, and 61.5% fitted the septic shock definition. A comparison of the septic shock and non-shock sepsis groups showed that a history of chronic liver disease, malignancy, pulse rate, prothrombin time, blood urea nitrogen, aspartate and alanine transaminase, troponin-I, Sequential Organ Failure Assessment score and procalcitonin levels were significantly higher in the septic shock group. In multivariate analysis, however, procalcitonin was an independent predictor for septic shock (adjusted odd ratio, 1.05; 95% confidential interval, 1.01-1.09). The area under the receiver operating characteristic curve was 0.729, and the cutoff value was 4.0 ng/mL. Conclusion The procalcitonin levels were higher in the septic shock group than in the non-shock sepsis group. This could help predict septic shock independently. Further prospective multicenter research is needed to determine if procalcitonin can predict the severity of sepsis.