Abstract 17663: Comparison of Length of Stay, Cost, and Radiation Exposure of Triple Rule Out versus Chest CT Angiogram followed by Cardiac Stress Testing for Evaluation of Chest Pain in the Emergency Department

Abstract

Objective: Undifferentiated chest pain in the emergency department (ED) often requires evaluation for both pulmonary embolus (PE) and cardiac-sourced chest pain (CSCP). One approach to this evaluation includes a chest CT followed by a cardiac stress test with myocardial perfusion imaging (MPI) if no PE is found (TRAD). An alternative evaluation for this population is a coronary CT angiogram with concurrent chest CT (Triple Rule Out, TRO). The objective of this study was to compare ED length of stay (LOS), hospital costs, and radiation exposure between these evaluation methods.

Methods: We performed a retrospective study of adult patients presenting to a large, academic, community ED for chest pain between February 2009 and January 2012 who had either TRAD or TRO. Demographics, body mass indexes (BMI), ED LOS (hours), hospital costs (dollars), and radiation exposure measurements (mSv) were collected. Thirty-day return visits for CSCP or PE were also evaluated for safety. Analyses were performed using JMP 9.0.2 and significance α = 0.05.

Results: Our study population included 829 patients who underwent TRAD and 642 patients who had TRO. TRO patients were significantly younger, mean age 52.3 years (95% CI 51.37, 53.23, p<0.001), had higher BMI, mean difference 2.36 (95% CI 1.62, 3.11, p<0.001), and were more likely to be male, 42.4% (p<0.001). No patient in either group had a related 30 day revisit. TRO patients had a significantly shorter ED LOS, mean difference 7.4 hours (95%CI 6.63, 8.18, p<0.001), incurred less cost (median $449.83 versus $1147.70, p<0.001), and were exposed to less radiation (median 7.18 mSv versus 16.6 mSv, p<0.001).

Conclusions: Both TRAD and TRO safely evaluated patients for CCSP and PE. TRO was associated with a shorter ED LOS, fewer hospital costs, and less exposure to radiation than traditional testing. Prospective studies evaluating this diagnostic strategy are needed to further assess this approach to ED chest pain evaluation.