Low-risk Patients with Chest Pain in the Emergency Department: Negative 64-MDCT Coronary Angiography May Reduce Length of Stay and Hospital Charges

Overview

Journal AJR Am J Roentgenol

Specialties Oncology
Radiology

Date 2009 Jun 23

PMID 19542407

Citations 9

Authors

Janet M May

William P Shuman

Jared N Strote

Kelley R Branch

Lee M Mitsumori

David W Lockhart

James H Caldwell

Affiliations

Soon will be listed here.

Abstract

Objective: The current standard-of-care workup of low-risk patients with chest pain in an emergency department takes 12-36 hours and is expensive. We hypothesized that negative 64-MDCT coronary angiography early in the workup of such patients may enable a shorter length of stay and reduce charges.

Materials And Methods: The standard-of-care evaluation consisted of serial cardiac enzyme tests, ECGs, and stress testing. After informed consent, we added cardiac CT early in the standard-of-care workup of 53 consecutive patients. Fifty patients had negative CT findings and were included in this series. The length of stay and charges were analyzed using actual patient data for all patients in the standard-of-care workup and for two earlier discharge scenarios based on negative cardiac CT results: First, CT plus serial enzyme tests and ECGs during an observation period followed by discharge if all were negative; and second, CT plus one set of enzyme tests and one ECG followed by discharge if all were negative. Comparisons were made using paired Student's t tests.

Results: For standard of care and the two CT-based earlier discharge analyses, the mean lengths of stay were 25.4, 14.3, and 5.0 hours; mean charges were $7,597, $6,153, and $4,251. Length of stay and charges were both significantly less (p < 0.001) for the two CT-based analyses.

Conclusion: In low-risk patients with chest pain, discharge from the emergency department based on negative cardiac CT, enzyme tests, and ECG may significantly decrease both length of stay and hospital charges compared with the standard of care.

Citing Articles

Efficacy of Coronary Computed Tomography Angiography Versus Nuclear Perfusion Stress in Preventing Downstream Imaging and Prolonged Inpatient Length of Stay in Low to Medium Risk Patients With Chest Pain.

Alonso M, Neicheril R, Shettigar S, Lavina A, Seijo de Armas Y, Carter A Cureus. 2022; 14(7):e27326.

PMID: 36042990 PMC: 9411707. DOI: 10.7759/cureus.27326.

A Heart Rate-Dependent Protocol of "One-Stop" Computed Tomography Angiography of Coronary Combined with Pulmonary Arteries Reduces the Dosages of Contrast Agent.

Yu H, Wang H, Gao Z, Chen G, Song H, Yan S Dose Response. 2022; 20(2):15593258221107906.

PMID: 35783237 PMC: 9247373. DOI: 10.1177/15593258221107906.

Short-Term Outcome of Discharged Low-Risk Chest Pain without Provoke Ischemia Study.

Sabzghabaei A, Asgarzadeh S, Miri R, Shojaee M, Alimohammadi H, Heidari K Emerg (Tehran). 2015; 2(1):18-21.

PMID: 26495336 PMC: 4614615.

Korean guidelines for the appropriate use of cardiac CT.

Kim Y, Yong H, Kim S, Kim J, Yang D, Hong Y Korean J Radiol. 2015; 16(2):251-85.

PMID: 25741189 PMC: 4347263. DOI: 10.3348/kjr.2015.16.2.251.

Diagnostic accuracy and clinical outcomes of ECG-gated, whole chest CT in the emergency department.

Branch K, Strote J, Shuman W, Mitsumori L, Busey J, Rue T PLoS One. 2013; 8(4):e61121.

PMID: 23613797 PMC: 3629052. DOI: 10.1371/journal.pone.0061121.

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