The disposition decision on emergency department patients with chest pain is affected by the results of multi-detector computed axial tomography scan of the coronary arteries.
BACKGROUND
Few data exist on the frequency with which multidetector computed axial tomography (MDCT) scan of the coronary arteries changes the admission decisions of emergency physicians (EP) caring for patients with possible acute coronary syndrome (ACS). We measured if and how often these changes in decision-making would occur.


METHODS
The theoretical dispositions of 27 emergency department patients who presented with possible ACS were determined by four board-certified EPs after case presentations. Paired disposition decisions were made before and after knowledge of the MDCT scan results. Patients were selected from a sample of 103 from a prior study.


RESULTS
The study included 27 patients with a mean age of 55 +/- 9 years; 58% were male. The low-, intermediate-, and high-risk MDCT scan results were evenly distributed, as were the original providers' standard clinical risk assessments of ACS. Three patients had ACS and all were admitted both before and after review of MDCT scan results. Among 24 patients without ACS, a decision to admit was changed to discharge in 16 of 90 admission decisions (18%, 95% confidence interval [CI] 10-26%). Among 6 patients with projected discharges, 2 were inappropriately admitted after review of MDCT scan results. The odds ratio of discharge for patients without ACS increased by 3.95 (95% CI 1.96-7.95) after introduction of the MDCT scan results.


CONCLUSIONS
An MDCT scan of the coronary arteries will likely change emergency physicians' decisions on the disposition of patients presenting with possible ACS, many to appropriate discharges but also a minority to inappropriate admissions.
Nagurney
John T
JT
Department of Emegency Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA.
Bamberg
Fabian
F
Nichols
John H
JH
Marill
Keith
K
Brown
David F M
DF
Peak
David A
DA
Harris
N Stuart
NS
Worrell
Stewart
S
Parry
Blair
B
Hoffmann
Udo
U
D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D002637:Chest Pain / Q000175:diagnosis / Q000209:etiology*; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D003657:Decision Making; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed / Q000379:methods*