title: The triple work-up for emergency department patients with acute chest pain: how often does it occur?
abstract: OBJECTIVE
  To measure the degree of overlap and diagnostic yield for evaluations of acute coronary syndrome (ACS), pulmonary embolism (PE), and aortic dissection (AD) among Emergency Department (ED) patients.
  
  
  METHODS
  We conducted a cross-sectional descriptive study of consecutive adult patients seen in the ED of a 78,000-annual-visit urban academic medical center. Patients who had received at least one of eight of the tests used in our ED to diagnose these three diseases were identified through three methods, and a final study population list was created. Overlap of evaluations and diagnostic yields were calculated by simple descriptive statistics.
  
  
  RESULTS
  Over a 2-week period, 626 patient encounters among 622 unique patients were identified. Among these 626 visits, 139 (22%) included diagnostic tests for more than one of the three diagnoses of interest. The majority of these multiple tests were for ACS plus PE (n = 121, 87% of all multiple tests), whereas a minority of patients received tests for ACS plus AD (n = 14, 10% of all multiple tests) or for the "triple work-up" of ACS plus PE plus AD (n = 4, 2.9% of all multiple tests).
  
  
  CONCLUSIONS
  Although the "triple work-up" evaluation for ACS, PE, and AD is relatively uncommon, a significant number of ED patients who are evaluated for at least one of these three major chest pain syndromes receive simultaneous testing for one of the others.
authors.affiliation: Tufts University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Rogg
authors.forename: Jan-Walter
authors.initials: JW
authors.lastname: De Neve
authors.forename: Calvin
authors.initials: C
authors.lastname: Huang
authors.forename: David
authors.initials: D
authors.lastname: Brown
authors.forename: Ik-Kyung
authors.initials: IK
authors.lastname: Jang
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Keith
authors.initials: K
authors.lastname: Marill
authors.forename: Blair
authors.initials: B
authors.lastname: Parry
authors.forename: Udo
authors.initials: U
authors.lastname: Hoffmann
authors.forename: John T
authors.initials: JT
authors.lastname: Nagurney
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis*; D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis*; D001014:Aortic Aneurysm / Q000150:complications / Q000175:diagnosis*; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000209:etiology*; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000150:complications / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed; D014692:Ventilation-Perfusion Ratio
chemical_list: D015415:Biomarkers