Triage of Patients Presenting With Chest Pain to the Emergency Department: Implementation of Coronary CT Angiography in a Large Urban Health Care System

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute chest pain with low risk of acute coronary syndrome (n=529). Intervention: Coronary CT angiography (CTA) triage protocol vs. Before implementation of triage protocol. Primary outcome: Length of stay (LOS) (51% decrease, p=<0.001).

Ricardo C. Cury; Gudrun Feuchtner; Juan C. Batlle; Constantino Peña; Warren R. Janowitz; Barry T. Katzen; Jack A. Ziffer

doi:10.2214/ajr.12.8808

December 19, 2012American Journal of Roentgenology

Triage of Patients Presenting With Chest Pain to the Emergency Department: Implementation of Coronary CT Angiography in a Large Urban Health Care System

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Key result

Implementation of a dedicated chest pain triage protocol using coronary CTA significantly decreased length of stay from 28.8 to 14.0 hours (p<0.001) and safely identified patients for discharge.

Why the study?

Does implementation of a coronary CTA-based triage protocol safely guide management and reduce length of stay in ED patients with low-risk chest pain?

Study Design

Type

Cohort (n=529)

Multicenter

Yes

Structured PICO

Does implementation of a coronary CTA-based triage protocol safely guide management and reduce length of stay in ED patients with low-risk chest pain?

P

Population

529 patients presenting to the emergency department with chest pain, negative cardiac enzyme results, normal or nondiagnostic ECG findings, and a thrombolysis in myocardial infarction (TIMI) risk score of 2 or less; mean age 52.1 years, 56% women.

I

Intervention

Coronary CT angiography (CTA) combined with a new dedicated chest pain triage protocol (levels 1-5) to stratify patients into 4 risk groups based on stenosis severity.

C

Comparator

Pre-implementation standard of care (for length of stay comparison).

O

Outcome

Major adverse cardiac events (MACEs) during the first 30 days after CTA, downstream testing results, and length of stay (LOS).composite

Main Result

Effect estimate: 51% decrease

Absolute Event Rate: 14% vs 28.8%

p-value: p=<0.001

Implementation of a dedicated coronary CTA triage protocol in the ED for low-risk chest pain safely allows early discharge and significantly reduces length of stay.

Implication

May support reduced ED stays with CTA triage in low-risk chest pain; leaves open need for randomized confirmation before practice change.

Discussion

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Cite This Study

Cury et al. (2012) conducted a cohort in Acute chest pain with low risk of acute coronary syndrome (n=529). Coronary CT angiography (CTA) triage protocol vs. Before implementation of triage protocol was evaluated on Length of stay (LOS) (51% decrease, p=<0.001). Implementation of a dedicated chest pain triage protocol using coronary CTA significantly decreased length of stay from 28.8 to 14.0 hours (p<0.001) and safely identified patients for discharge.

synapsesocial.com/papers/6a0904932757fd3263d3a403 https://doi.org/10.2214/ajr.12.8808

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Triage of Patients Presenting With Chest Pain to the Emergency Department: Implementation of Coronary CT Angiography in a Large Urban Health Care System

Study Design

Structured PICO

Main Result

Implication

Discussion

Cite This Study

Triage of Patients Presenting With Chest Pain to the Emergency Department: Implementation of Coronary CT Angiography in a Large Urban Health Care System

Study Design

Structured PICO

Main Result

Implication

Discussion

Cite This Study

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