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Low-Risk Patients With Chest Pain in the Emergency Department

Negative 64-MDCT Coronary Angiography May Reduce Length of Stay and Hospital Charges

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.
Non-invasive Imaging: Nuclear Cardiology


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 CTbased 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.

References


AJR 2009; 193:150–154

Notes to editor


When thinking about cardiac CT in the emergency department, this might be useful to come to an earlier triage of patients and to shorten the length of stay.
This concept was evaluated in the present study indicating that CT might indeed be useful in the triage of “low risk patients” in the emergency room.
However, the patient number is low (n=53!), and no follow-up data are reported.
The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.

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