title: The feasibility of nurse-led assessment in acute chest pain admissions by means of coronary computed tomography.
abstract: BACKGROUND
  Cardiac computed tomography (CCT) is a non-invasive imaging technique for the diagnosis of coronary artery disease (CAD). The National Institute for Health and Clinical Excellence (NICE) recommend CCT for selected patients in the assessment of chest pain of recent onset.
  
  
  OBJECTIVE
  To assess the feasibility and utility of CCT in a nurse-led, protocol-based assessment of chest pain.
  
  
  METHODS
  Patients admitted over 4 months with suspected angina were assessed for eligibility for CCT by a specialist nurse. Eligibility was defined by: a likelihood of CAD < 90%, no features of acute coronary syndrome, no contra-indications to the scanning process, and the ability to give written consent. An age and sex-matched historical cohort (for whom CCT was unavailable) was compared with the CCT cohort with regard to the diagnosis or exclusion of CAD at 3 months post-discharge from hospital.
  
  
  RESULTS
  Of 198 patients admitted, 98 were identified as eligible for CCT. Of these, 37 were recommended for alternative management on cardiologist review, 18 declined consent, 23 were unable to be scanned within 24 h prior to discharge and 14 underwent CCT. CAD was diagnosed or excluded in 14/14 patients undergoing CCT. CAD was diagnosed or excluded in 11/14 patients investigated without CCT, leaving 3/14 patients with no clear diagnosis.
  
  
  CONCLUSIONS
  This study suggests nurses may be trained to assess patients for CCT within agreed protocols. In the UK it is likely these protocols will be based on NICE guidance. Despite potential diagnostic utility, CCT appears likely to form a small percentage of cardiac investigations undertaken.
authors: 1Department of Medicine & Therapeutics, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW10 9NH United Kingdom. cmpatterson@doctors.net.uk
authors: Caroline
authors: C
authors: Patterson
authors: Leoni
authors: L
authors: Bryan
authors: Mark
authors: M
authors: Duncan
authors: Julian
authors: J
authors: Collinson
authors: Simon
authors: S
authors: Padley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000000981:diagnostic imaging / Q000451:nursing; D002983:Clinical Competence; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000451:nursing; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods / Q000706:statistics & numerical data; D007857:Leadership; D008297:Male; D008875:Middle Aged; D009720:Nurse Clinicians / Q000458:organization & administration*; D009730:Nursing Assessment; D009746:Nursing, Team / Q000458:organization & administration*; D010343:Patient Admission / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000379:methods / Q000706:statistics & numerical data*; D006113:United Kingdom; D055815:Young Adult