Abstract 15162: Assessment of Appropriate Use Criteria for Stress Echocardiography in the Emergency Room Evaluation of Chest Pain
Introduction: Rational use of imaging is needed in all healthcare settings, including the emergency room (ER). The aim of this study was to assess the application of the American College of Cardiology/American Society of Echocardiography appropriate use criteria for stress echocardiography (SE) in the ER evaluation of chest pain.
Hypothesis: We assessed the hypothesis that the ER generates a significant number of inappropriate SE studies and that inappropriate SE referred from the ER would have significant gender, risk factor, and age differences compared to appropriate SE.
Methods: In this retrospective analysis, SE referred from the ER at a single-center university hospital from January 2006 to June 2011 were reviewed. The patient records were analyzed to determine SE indication and classification as appropriate, uncertain, or inappropriate. We compared patient characteristics for appropriate and inappropriate studies using t-tests and chi-square analysis.
Results: Of 141 SE studies, 71 (50%) were classified as appropriate, 69 (49%) were inappropriate, and 1 (1%) was uncertain. Females were more likely than males to be referred for inappropriate studies (odds ratio, 16.7; 95% confidence interval, 5.0-55.6; p<0.0001). SE ordered for males were appropriate 91% (30/33) of the time, compared to 38% (41/107) for females (p<0.0001). Patients with inappropriately ordered studies were significantly younger than those with appropriately ordered studies (mean age = 47.8 ± 7.3 vs. 56.9 ± 8.8, respectively, p<0.0001). All patients with inappropriately ordered studies had low pre-test probability for coronary artery disease (100%, p<0.0001). Inappropriate SE was not associated with diabetes, hypertension, hyperlipidemia, tobacco use, family history, EKG interpretability, or patient’s Framingham risk score.
Conclusions: In this analysis, nearly half of SE studies ordered in the ER for evaluation of chest pain were inappropriate. Owing to their lower pre-test probability of disease, younger patients and women were most likely to receive an inappropriate SE. More attention should be given to pre-test probability, in particular age and gender, when determining which patients should be referred for stress echocardiography from the ER.
- © 2012 by American Heart Association, Inc.