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• W2330247540 abstract "Study Objectives: Chest pain is one of the most common chief complaints evaluated in the emergency department (ED). Symptoms are often non-specific and require testing to rule-out life threatening causes, such as ischemic heart disease or pulmonary embolism. The traditional approach to evaluating these patients is chest CT with subsequent provocative testing (Trad), often graded exercise stress with myocardial perfusion imaging (MPI). Coronary CTA with concurrent chest CT (Triple Rule Out, TRO) is a diagnostic approach for these patients, but little data exists regarding the ability of TRO to exclude acute pathology. For this reason, the objective of this study was to compare the short term adverse events for patients being evaluated in the ED by TRO versus traditional evaluation methods. Methods: We performed a retrospective study of adult patients presenting to a large, academic, community ED for chest pain evaluation between February 2009 and January 2012. Patients were included if they 1) had TRO study or 2) had Trad testing. Demographics and process data were collected, including total length of stay (LOS). Our primary outcome was revisit for major cardiac adverse event (MACE) or venous thromboembolic disease (VTE) within 30 days of the initial admission. Revisits were manually reviewed by investigators for presence of study outcomes. Pearson Chi-Square or the unequal variance T-test was used as appropriate to test for differences between groups. Analyses were performed using JMP 9.0.2 and significance α = 0.05. Results: A total of 7749 patients had chest CT, with 4352 (56%) admitted for an abnormal study. Our study population included 829 patients who went on to have provocative testing (Trad) and 642 patients who had TRO. TRO patients were significantly younger, mean age 52.3 years (95% CI 51.37, 53.23, p-value <0.001), and more likely to be male, 42.4% (p-value <0.001). For the Trad cohort, 739 (89%) patients were discharged home, and within 30 days, 80 (10.5%) patients revisited the ED. For the TRO cohort, 539 (84.0%) were discharged home, and within 30 days, 37 (6.6%) patients revisited the ED. Patients in the Trad cohort were significantly more likely to return to the ED within 30 days (p-value 0.014); however, no patient in either group had a return visit for major cardiac adverse event or venous thromboembolic disease (TRO 0 (95% CI 0.0, 0.007) and Trad 0 (95% CI 0.0, 0.005)). For patients discharged from the ED, TRO patients had a significantly shorter LOS, mean difference 7.4 hours (95% CI 6.63, 8.18, p-value <0.001). Conclusion: No patient in the TRO or traditional cohort had a short term adverse event, identifying that both methods are effective at ruling out short term events. The TRO patients had a significantly shorter ED length of stay. This study suggests that TRO is an effective modality for excluding life-threatening causes of chest pain in the ED. Prospective studies evaluating this diagnostic strategy are needed to further assess this approach to ED chest pain evaluation." @default.
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• W2330247540 date "2012-10-01" @default.
• W2330247540 modified "2023-09-26" @default.
• W2330247540 title "20 Comparison of 30-Day Adverse Events Following Triple Rule Out Versus Chest CT With Subsequent Provocative Testing for Evaluation of Chest Pain in the Emergency Department" @default.
• W2330247540 doi "https://doi.org/10.1016/j.annemergmed.2012.06.047" @default.
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