A time and imaging cost analysis of low-risk ED observation patients: A conservative 64-section computed tomography coronary angiography "triple rule-out" compared to nuclear stress test strategy

American Journal of Emergency Medicine

Volumn 29, Issue 2, 2011, Pages 187-195

  Takakuwa, Kevin M ^a   Halpern, Ethan J ^a   Shofer, Frances S ^b  

^a THOMAS JEFFERSON UNIVERSITY HOSPITAL   (United States)

^b UNIVERSITY OF PENNSYLVANIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

HEART ENZYME;

ACUTE CORONARY SYNDROME; ADULT; ANGIOCARDIOGRAPHY; ARTICLE; COHORT ANALYSIS; COMPUTED TOMOGRAPHY CORONARY ANGIOGRAPHY; CORONARY ARTERY DISEASE; COST BENEFIT ANALYSIS; COST CONTROL; EMERGENCY WARD; EXERCISE TEST; FEMALE; HUMAN; INTERMETHOD COMPARISON; LENGTH OF STAY; LUNG EMBOLISM; MAJOR CLINICAL STUDY; MALE; MULTIDETECTOR COMPUTED TOMOGRAPHY; OBSERVATIONAL METHOD; PRIORITY JOURNAL; PROSPECTIVE STUDY; SYMPTOM; THORAX DISEASE; THORAX PAIN;

ACUTE CORONARY SYNDROME; CHEST PAIN; CORONARY ANGIOGRAPHY; COST-BENEFIT ANALYSIS; EMERGENCY SERVICE, HOSPITAL; EXERCISE TEST; FEMALE; HUMANS; LENGTH OF STAY; MALE; MIDDLE AGED; OBSERVATION; PHILADELPHIA; PROSPECTIVE STUDIES; TIME FACTORS; TOMOGRAPHY, X-RAY COMPUTED;

EID: 78751673007     PISSN: 07356757     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.ajem.2009.09.002     Document Type: Article

References (46)

1. Pope J.H., Aufderheide T.P., Ruthazer R., Woolard R.H., Feldman J.A., and Beshansky J.R. Missed diagnoses of acute cardiac ischemia in the emergency department N Engl J Med 342 2000 1163 1170
2. Schull M., Vermeulen M.J., and Stukel T.A. The risk of missed diagnosis of acute myocardial infarction associated with emergency department volume Ann Emerg Med 48 2006 647 655
3. Rusnak R.A., Stair T.O., Hansen K., and Fastow J.S. Litigation against the emergency physician: common features in cases of missed myocardial infarction Ann Emerg Med 18 1989 1029 1034
4. Burke V., O'Neil B.J., and Gawad Y. Undiagnosed myocardial infarction: liability before and after thrombolytic therapy [abstract] Acad Emerg Med 3 1996 489
5. Tosteson A.N., Goldman L., Udvarhelyi I.S., and Lee T.H. Cost-effectiveness of a coronary care unit versus an intermediate care unit for emergency department patients with chest pain Circulation 94 1996 143 150
6. Storrow A.B., and Gibler W.B. Chest pain centers: diagnosis of acute coronary syndromes Ann Emerg Med 35 2000 449 461
7. Gibler W.B., Runyon J.P., Levy R.C., Sayre M.R., Kacich R., and Hattemer C.R. A rapid diagnostic and treatment center for patients with chest pain in the emergency department Ann Emerg Med 25 1995 1 8
8. Tatum J.L., Jesse R.L., Kontos M.C., Nicholson C.S., Schmidt K.L., and Roberts C.S. Comprehensive strategy for the evaluation and triage of the chest pain patient Ann Emerg Med 29 1997 116 125
9. Farkouh M.E., Smars P.A., Reeder G.S., Zinsmeister A.R., Evans R.W., and Meloy T.D. clinical trial of a chest-pain observation unit for patients with unstable angina. Chest Pain Evaluation in the Emergency Room (CHEER) Investigators N Engl J Med 339 1998 1882 1888
10. Zalenski R.J., Selker H.P., Cannon C.P., Farin H.M., Gibler W.B., and Goldberg R.J. National Heart Attack Alert Program position paper: chest pain centers and programs for the evaluation of acute cardiac ischemia Ann Emerg Med 35 2000 462 471
11. Fesmire F.M., Hughes A.D., Fody E.P., Jackson A.P., Fesmire C.E., and Gilbert M.A. The Erlanger chest pain evaluation protocol: a one-year experience with serial 12-lead ECG monitoring, two-hour delta serum marker measurements, and selective nuclear stress testing to identify and exclude acute coronary syndromes Ann Emerg Med 40 2002 584 594
12. Gianrossi R., Detrano R., Mulvihill D., Lehmann K., Dubach P., and Colombo A. Depression in the diagnosis of coronary artery disease. A meta-analysis Circulation 80 1989 87 98
13. Fleischmann K.E., Hunink M.G., Kuntz K.M., and Douglas P.S. Exercise echocardiography or exercise SPECT imaging? A meta-analysis of diagnostic test performance JAMA 280 1998 913 920
14. Klocke F.J., Baird M.G., Lorell B.H., Bateman T.M., Messer J.V., and Berman D.S. ACC/AHA/ASNC guidelines for the clinical use of cardiac radionuclide imaging-executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASNC Committee to Revise the 1995 Guidelines for the Clinical Use of Cardiac Radionuclide Imaging) J Am Coll Cardiol 42 2003 1318 1333
15. Leschka S., Alkadhi H., Plass A., Desbiolles L., Grunenfelder J., and Marincek B. Accuracy of MSCT coronary angiography with 64-slice technology: first experience Eur Heart J 26 2005 1482 1487
16. Mollet N.R., Cademartiri F., van Mieghem C.A., Runza G., McFadden E.P., and Baks T. High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography Circulation 112 2005 2318 2323
17. Raff G.L., Gallagher M.J., O'Neill W.W., and Goldstein J.A. Diagnostic accuracy of noninvasive coronary angiography using 64-slice spiral computed tomography J Am Coll Cardiol 46 2005 552 557
18. Fine J.J., Hopkins C.B., Ruff N., and Newton F.C. Comparison of accuracy of 64-slice cardiovascular computed tomography with coronary angiography in patients with suspected coronary artery disease Am J Cardiol 97 2006 173 174
19. Hoffmann U., Pena A.J., Moselewski F., Ferencik M., Abbara S., and Cury R.C. MDCT in early triage of patients with acute chest pain AJR Am J Roentgenol 187 2006 1240 1247 (Pubitemid 44630827)
20. Pugliese F., Mollet N.R., Runza G., van Mieghem C., Meijboom W.B., and Malagutti P. Diagnostic accuracy of non-invasive 64-slice CT coronary angiography in patients with stable angina pectoris Eur Radiol 16 2006 575 582
21. Schuijf J.D., Pundziute G., Jukema J.W., Lamb H.J., van der Hoeven B.L., and de Roos A. Diagnostic accuracy of 64-slice multislice computed tomography in the noninvasive evaluation of significant coronary artery disease Am J Cardiol 98 2006 145 148 (Pubitemid 43975510)
22. Muhlenbruch G., Seyfarth T., Soo C.S., Pregalathan N., and Mahnken A.H. Diagnostic value of 64-slice multi-detector row cardiac CTA in symptomatic patients Eur Radiol 17 2007 603 609
23. Oncel D., Oncel G., Tastan A., and Tamci B. Detection of significant coronary artery stenosis with 64-section MDCT angiography Eur J Radiol 62 2007 394 405
24. Schlosser T., Mohrs O.K., Magedanz A., Nowak B., Voigtlander T., and Barkhausen J. Noninvasive coronary angiography using 64-detector-row computed tomography in patients with a low to moderate pretest probability of significant coronary artery disease Acta Radiol 48 2007 300 307
25. Hoffmann U., Nagurney J.T., and Moselewski F. Coronary multidetector computed tomography in the assessment of patients with acute chest pain Circulation 114 2006 2251 2260
26. Gallagher M.J., Ross M.A., Raff G.L., Goldstein J.A., O'Neill W.W., and O'Neil B. The diagnostic accuracy of 64-slice computed tomography coronary angiography compared with stress nuclear imaging in emergency department low-risk chest pain patients Ann Emerg Med 49 2007 125 136
27. Hollander J.E., Litt H.I., Chase M., Brown A.M., Kim W., and Baxt W.G. Computed tomography coronary angiography for rapid disposition of low-risk emergency department patients with chest pain syndromes Acad Emerg Med 14 2007 112 116
28. Pundziute G., Schuijf J.D., Jukema J.W., Boersma E., de Roos A., and van der Wall E.E. Prognostic value of multislice computed tomography coronary angiography in patients with known or suspected coronary artery disease J Am Coll Cardiol 49 2007 62 70 (Pubitemid 46026899)
29. Rubinshtein R., Halon D.A., Gaspar T., Jaffe R., Karkabi B., and Flugelman M.Y. Usefulness of 64-slice cardiac computed tomographic angiography for diagnosing acute coronary syndromes and predicting clinical outcome in emergency department patients with chest pain of uncertain origin Circulation 115 2007 1762 1768 (Pubitemid 46648613)
30. Takakuwa K.M., and Halpern E.J. Evaluation of a "triple rule-out" coronary CT angiography protocol: use of 64-section CT in low-to-moderate risk emergency department patients suspected of having acute coronary syndrome Radiology 248 2008 438 446
31. Savino G., Herzog C., Costello P., and Schoepf U.J. 64 slice cardiovascular CT in the emergency department: concepts and first experiences Radiol Med 111 2006 481 496
32. Johnson T.R., Nikolaou K., and Wintersperger B.J. ECG-gated 64-MDCT angiography in the differential diagnosis of acute chest pain AJR Am J Roentgenol 188 2007 76 82
33. Johnson T.R., Nikolaou K., and Becker A. Dual-source CT for chest pain assessment Eur Radiol 18 2008 773 780
34. Morrow D.A., Antman E.M., Charlesworth A., Cairns R., Murphy S.A., and de Lemos J.A. TIMI risk score for ST-elevation myocardial infarction: a convenient, bedside, clinical score for risk assessment at presentation: an intravenous nPA for treatment of infarcting myocardium early II trial substudy Circulation 102 2000 2031 2037
35. Antman E.M., Cohen M., Bernink P.J., McCabe C.H., Horacek T., and Papuchis G. The TIMI risk score for unstable angina/non-ST elevation MI: a method for prognostication and therapeutic decision making JAMA 284 2000 835 842
36. http://www.highmarkmedicareservices.com/partb/reimbursement/calc-2008. html.
37. Williams R.M. The costs of visits to emergency departments N Engl J Med 334 1996 642 646
38. Bamezai A., Melnick G., and Nawathe A. The cost of an emergency department visit and its relationship to the emergency department volume Ann Emerg Med 45 2005 483 490
39. Ladapo J.A., Hoffmann U., Bamberg F., Nagurney J.T., Cutler D.M., and Weinstein M.C. Cost-effectiveness of coronary MDCT in the triage of patients with acute chest pain AJR Am J Roentgenol 191 2008 455 463
40. Khare R.K., Courtney D.M., Powell E.S., Venkatesh A.K., and Lee T.A. Sixty-four-slice computed tomography of the coronary arteries: cost-effectiveness analysis of patients presenting to the emergency department with low-risk chest pain Acad Emerg Med 15 2008 623 632
41. Chang A.M., Shofer F.S., Weiner M.G., Synnestvedt M.B., Litt H.I., and Baxt W.G. Actual financial comparison of four strategies to evaluate patients with potential Acute Coronary Syndromes Acad Emerg Med 15 2008 649 655
42. May J.M., Shuman W.P., Strote J.N., Branch K.R., Mitsumori L.M., and Lockhart D.W. Low-risk patients with chest pain in the emergency department: negative 64-MDCT coronary angiography may reduce length of stay and hospital charges AJR Am J Roentgenol 193 2009 150 154
43. Min J.K., Kang N., Shaw L.J., Devereux R.B., Robinson M., and Lin F. Costs and clinical outcomes after coronary multidetector CT angiography in patients without known coronary artery disease: comparison to myocardial perfusion SPECT Radiology 249 2008 62 70
44. Halpern E.J. Triple-rule-out CT angiography for evaluation of acute chest pain and possible acute coronary syndrome Radiology 252 2009 332 345
45. deFilippi C.R., Rosanio S., Tocchi M., Parmar R.J., Potter M.A., and Uretsky B.F. Randomized comparison of a strategy of predischarge coronary angiography versus exercise testing in low-risk patients in a chest pain unit: in-hospital and long-term outcomes J Am Coll Cardiol 37 2001 2042 2049
46. Shoyeb A., Bokhari S., Sullivan J., Hurley E., Miesner B., and Pia R. Value of definitive diagnostic testing in the evaluation of patients presenting to the emergency department with chest pain Am J Cardiol 91 2003 1410 1414