Comparative diagnostic yield and 3-month outcomes of “triple rule-out” and standard protocol coronary CT angiography in the evaluation of acute chest pain

Madder, Ryan D.; Raff, Gilbert; Hickman, Leaden; Foster, Nathan; McMurray, Mark D.; Carlyle, Lynn; Boura, Judith; Chinnaiyan, Kavitha M.

doi:10.1016/j.jcct.2011.03.008

Cited by 54 publications

(39 citation statements)

References 26 publications

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“…12 In our cohort, the yield of neuroimaging (particularly MRI) to evaluate dangerous causes of dizziness was modest but not altogether different from the diagnostic yield (14%) of chest CT to rule out coronary disease and pulmonary embolism for patients with acute chest pain, which is a symptom complex of similar frequency, resource utilization, and illness severity. 13,14 Furthermore, there did not appear to be significant variation a Clinical factors that were significantly associated with the outcome in univariate analysis (P < .10) were included in the final multivariable model. Significant predictors (P < .10 at the univariate level and P < .05 at the multivariate level) are in boldface.…”

Section: Discussionmentioning

confidence: 95%

The Use of Neuroimaging Studies and Neurological Consultation to Evaluate Dizzy Patients in the Emergency Department

Navi

Kamel

Shah

et al. 2012

The Neurohospitalist

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Background and Purpose: Dizziness is a frequent reason for neuroimaging and neurological consultation, but little is known about the utility of either practice. We sought to characterize the patterns and yield of neuroimaging and neurological consultation for dizziness in the emergency department (ED). Methods: We retrospectively identified consecutive adults presenting to an academic ED from 2007 to 2009, with a primary complaint of dizziness, vertigo, or imbalance. Neurologists reviewed medical records to determine clinical characteristics, whether a neuroimaging study (head computed tomography [CT] or brain magnetic resonance imaging [MRI]) or neurology consultation was obtained in the ED, and to identify relevant findings on neuroimaging studies. Two neurologists assigned a final diagnosis for the cause of dizziness. Logistic regression was used to evaluate bivariate and multivariate predictors of neuroimaging and consultation. Results: Of 907 dizzy patients (mean age 59 years; 58% women), 321 (35%) had a neuroimaging study (28% CT, 11% MRI, and 4% both) and 180 (20%) had neurological consultation. Serious neurological disease was ultimately diagnosed in 13% of patients with neuroimaging and 21% of patients with neurological consultation, compared to 5% of the overall cohort. Headache and focal neurological deficits were associated with both neuroimaging and neurological consultation, while age ≥ 60 years and prior stroke predicted neuroimaging but not consultation, and positional symptoms predicted consultation but not neuroimaging. Conclusion: In a tertiary care ED, neuroimaging and neurological consultation were frequently utilized to evaluate dizzy patients, and their diagnostic yield was substantial.

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Section: Discussionmentioning

confidence: 95%

The Use of Neuroimaging Studies and Neurological Consultation to Evaluate Dizzy Patients in the Emergency Department

Navi

Kamel

Shah

et al. 2012

The Neurohospitalist

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“…By potentially eliminating the need for further diagnostic testing, a TRO approach seems to improve the efficiency and downstream clinical outcomes of acute chest pain evaluation [25]. However, the implementation of TRO protocol is not without some drawbacks.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Acute Coronary Syndrome in Patients Suspected for Pulmonary Embolism or Acute Aortic Syndrome: Rationale for the Triple Rule-Out Concept

et al. 2015

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BackgroundThe aims of the study were to evaluate the prevalence of acute coronary syndrome (ACS) among patients presenting with atypical chest pain who are evaluated for acute aortic syndrome (AAS) or pulmonary embolism (PE) with computed tomoangiography (CTA) and discuss the rationale for the use of triple rule-out (TRO) protocol for triaging these patients.MethodsThis study is a retrospective analysis of patients presenting with atypical chest pain and evaluated with thoracic (CTA), for suspicion of AAS/PE. Two physicians reviewed patient files for demographic characteristics, initial CT and final clinical diagnosis. Patients were classified according to CTA finding into AAS, PE and other diagnoses and according to final clinical diagnosis into AAS, PE, ACS and other diagnoses.ResultsFour hundred and sixty-seven patients were evaluated: 396 (84.8%) patients for clinical suspicion of PE and 71 (15.2%) patients for suspicion of AAS. The prevalence of ACS and AAS was low among the PE patients: 5.5% and 0.5% respectively (P = 0.0001), while the prevalence of ACS and PE was 18.3% and 5.6% among AAS patients (P = 0.14 and P = 0.34 respectively).ConclusionThe prevalence of ACS and AAS among patients suspected clinically of having PE is limited while the prevalence of ACS and PE among patients suspected clinically of having AAS is significant. Accordingly patients suspected for PE could be evaluated with dedicated PE CTA while those suspected for AAS should still be triaged using TRO protocol.

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“…Aortic dissection [ Fig. 15] can be seen on a dedicated CTCA [95] but it is not borne out in studies due to the low incidence, which affects prospective dedicated triplerule out trials [96]. One study looked at 50 retrospective cases of acute aortic syndrome (including 7 cases of atherosclerotic ulcer, 38 aortic dissections and 5 cases of intramural haematoma) and found that all were visible (although not necessarily the entry tear site) in the limited area imaged on a CTCA [97].…”

Section: Extra-cardiac Causes Of Chest Pain On Ctcamentioning

confidence: 99%

CT coronary angiography in the investigation of chest pain — Beyond coronary artery atherosclerosis; A pictorial review

Kanaganayagam

Ngo

Alsafi

et al. 2014

International Journal of Cardiology

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Comparative diagnostic yield and 3-month outcomes of “triple rule-out” and standard protocol coronary CT angiography in the evaluation of acute chest pain

Cited by 54 publications

References 26 publications

The Use of Neuroimaging Studies and Neurological Consultation to Evaluate Dizzy Patients in the Emergency Department

The Use of Neuroimaging Studies and Neurological Consultation to Evaluate Dizzy Patients in the Emergency Department

Prevalence of Acute Coronary Syndrome in Patients Suspected for Pulmonary Embolism or Acute Aortic Syndrome: Rationale for the Triple Rule-Out Concept

CT coronary angiography in the investigation of chest pain — Beyond coronary artery atherosclerosis; A pictorial review

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