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Triple Rule Out versus CT Angiogram Plus Stress Test for Evaluation of Chest Pain in the Emergency Department.

Sawyer KN, Shah P, Qu L, Kurz MC, Clark CL, Swor RA - West J Emerg Med (2015)

Bottom Line: The objective of this study was to describe the ED patient course and short-term safety for these evaluation methods.No patient in either group had a related 30-day revisit.Both TRAD and TRO safely evaluated patients.

View Article: PubMed Central - PubMed

Affiliation: William Beaumont Hospital, Department of Emergency Medicine, Royal Oak, Michigan.

ABSTRACT

Introduction: Undifferentiated chest pain in the emergency department (ED) is a diagnostic challenge. One approach includes a dedicated chest computed tomography (CT) for pulmonary embolism or dissection followed by a cardiac stress test (TRAD). An alternative strategy is a coronary CT angiogram with concurrent chest CT (Triple Rule Out, TRO). The objective of this study was to describe the ED patient course and short-term safety for these evaluation methods.

Methods: This was a retrospective observational study of adult patients presenting to a large, community ED for acute chest pain who had non-diagnostic electrocardiograms (ECGs) and normal biomarkers. We collected demographics, ED length of stay, hospital costs, and estimated radiation exposures. We evaluated 30-day return visits for major adverse cardiac events.

Results: A total of 829 patients underwent TRAD, and 642 patients had TRO. Patients undergoing TRO tended to be younger (mean 52.3 vs 56.5 years) and were more likely to be male (42.4% vs. 30.4%). TRO patients tended to have a shorter ED length of stay (mean 14.45 vs. 21.86 hours), to incur less cost (median $449.83 vs. $1147.70), and to be exposed to less radiation (median 7.18 vs. 16.6 mSv). No patient in either group had a related 30-day revisit.

Conclusion: Use of TRO is feasible for assessment of chest pain in the ED. Both TRAD and TRO safely evaluated patients. Prospective studies investigating this diagnostic strategy are needed to further assess this approach to ED chest pain evaluation.

No MeSH data available.


Related in: MedlinePlus

Patient summary diagram.ECG, electrocardiogram; CT, computed tomography; ACS, acute coronary syndrome; TRAD, traditional group; TRO, triple rule out group; ED, emergency department; MACE, major adverse cardiac event; VTE, venous thromboembolism
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f1-wjem-16-677: Patient summary diagram.ECG, electrocardiogram; CT, computed tomography; ACS, acute coronary syndrome; TRAD, traditional group; TRO, triple rule out group; ED, emergency department; MACE, major adverse cardiac event; VTE, venous thromboembolism

Mentions: This study investigated two populations (Figure): 829 patients who were evaluated using TRAD and 642 patients who were evaluated using TRO.


Triple Rule Out versus CT Angiogram Plus Stress Test for Evaluation of Chest Pain in the Emergency Department.

Sawyer KN, Shah P, Qu L, Kurz MC, Clark CL, Swor RA - West J Emerg Med (2015)

Patient summary diagram.ECG, electrocardiogram; CT, computed tomography; ACS, acute coronary syndrome; TRAD, traditional group; TRO, triple rule out group; ED, emergency department; MACE, major adverse cardiac event; VTE, venous thromboembolism
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4644034&req=5

f1-wjem-16-677: Patient summary diagram.ECG, electrocardiogram; CT, computed tomography; ACS, acute coronary syndrome; TRAD, traditional group; TRO, triple rule out group; ED, emergency department; MACE, major adverse cardiac event; VTE, venous thromboembolism
Mentions: This study investigated two populations (Figure): 829 patients who were evaluated using TRAD and 642 patients who were evaluated using TRO.

Bottom Line: The objective of this study was to describe the ED patient course and short-term safety for these evaluation methods.No patient in either group had a related 30-day revisit.Both TRAD and TRO safely evaluated patients.

View Article: PubMed Central - PubMed

Affiliation: William Beaumont Hospital, Department of Emergency Medicine, Royal Oak, Michigan.

ABSTRACT

Introduction: Undifferentiated chest pain in the emergency department (ED) is a diagnostic challenge. One approach includes a dedicated chest computed tomography (CT) for pulmonary embolism or dissection followed by a cardiac stress test (TRAD). An alternative strategy is a coronary CT angiogram with concurrent chest CT (Triple Rule Out, TRO). The objective of this study was to describe the ED patient course and short-term safety for these evaluation methods.

Methods: This was a retrospective observational study of adult patients presenting to a large, community ED for acute chest pain who had non-diagnostic electrocardiograms (ECGs) and normal biomarkers. We collected demographics, ED length of stay, hospital costs, and estimated radiation exposures. We evaluated 30-day return visits for major adverse cardiac events.

Results: A total of 829 patients underwent TRAD, and 642 patients had TRO. Patients undergoing TRO tended to be younger (mean 52.3 vs 56.5 years) and were more likely to be male (42.4% vs. 30.4%). TRO patients tended to have a shorter ED length of stay (mean 14.45 vs. 21.86 hours), to incur less cost (median $449.83 vs. $1147.70), and to be exposed to less radiation (median 7.18 vs. 16.6 mSv). No patient in either group had a related 30-day revisit.

Conclusion: Use of TRO is feasible for assessment of chest pain in the ED. Both TRAD and TRO safely evaluated patients. Prospective studies investigating this diagnostic strategy are needed to further assess this approach to ED chest pain evaluation.

No MeSH data available.


Related in: MedlinePlus