EDACS Score: Emergency Department Assessment of Chest Pain Score. Identifies patients safe for 2-hour early discharge.
45 years
Sex
Age 18-50 AND (known CAD or ≥3 risk factors)
Diaphoresis
Pain radiates to arm, shoulder, neck, or jaw
Pain worsened by inspiration (-4 pts)
Pain reproduced by palpation (-6 pts)
Guidelines & Evidence
Clinical Details
Section 1
When to Use
When to Use
Adult patients presenting to the Emergency Department with symptoms suggestive of acute coronary syndrome (ACS)
Used to identify a cohort of patients at sufficiently low risk of major adverse cardiac events (MACE) to be safely discharged at 2 hours
Do Not Use If
Patient has unequivocal ongoing ischemia, dynamic ECG changes, hemodynamic instability, or another emergent cause for chest pain (e.g., aortic dissection, pulmonary embolism).
Section 2
Formula & Logic
Scoring Logic
The EDACS (Emergency Department Assessment of Chest Pain Score) incorporates age, sex, risk factors, and classical symptom presentation to calculate risk. Notably, elements that make ACS *less* likely (pain with inspiration, pain on palpation) subtract points.
Integrating with Troponin
01
1. Calculate the EDACS score. A score < 16 identifies the patient as "Low Risk".
3. Obtain a high-sensitivity troponin at 0-hour and 2-hours. Both must be normal/negative according to local assay thresholds.
04
4. If all three criteria (EDACS < 16, normal ECG, negative 0h/2h trops) are met, the patient is safe for early discharge.
Section 3
Pearls/Pitfalls
EDACS vs HEART Score
While the HEART score uses the physician's subjective assessment of the chest pain history ("highly suspicious", "moderately suspicious"), EDACS relies on explicitly defined symptoms (diaphoresis, radiation). This makes EDACS more objective and potentially more reproducible, particularly for less experienced clinicians.
Efficiency
Studies comparing EDACS to the ADAPT protocol (incorporating TIMI) and HEART pathway have consistently shown that EDACS identifies a higher proportion of patients (up to 40-50%) as safe for early discharge without missing additional MACE.
Section 4
Evidence Appraisal
Original Derivation
Development and validation of the Emergency Department Assessment of Chest pain Score and 2 h accelerated diagnostic protocol.
Than M et al. • Emerg Med Australas.. 2014;26(1):34-44. Derived in 1974 patients and validated in a separate cohort. Demonstrated 100% sensitivity for MACE when combined with 0/2h troponins and ECG.
Large-scale Validation
Performance of the EDACS-ADP in a Large Community-based Cohort.
Mark DG et al. • Ann Emerg Med.. 2018;71(5):609-618. Retrospective validation in over 118,000 patients across Kaiser Permanente. Replicated the high sensitivity (>99%) and high proportion of patients identified for early discharge.
