CT Scans Used To Determine Heart Disease in the Emergency Room

If the diagnosis is negative, the patient can go home, and the total time at the hospital will be much shorter than it is today.

That is the hypothesis behind a study presented in November 2007 at the annual meeting of the Radiological Society of North America (RSNA), held in Chicago, IL, USA, by Rajan Agarwal, M.D., a resident in radiology at the University of Pennsylvania School of Medicine (Philadelphia, PA, USA). "The cost of chest pain triage [where patients in the emergency department are prioritized based on their symptoms] and management has been estimated to be as high as US$8 billion annually, with most patients ultimately not having to remain in the hospital. Therefore, there is a tremendous opportunity to reduce healthcare costs if we can demonstrate the cost-effectiveness of this procedure with low-risk patients who go to the emergency department.”

Furthermore, this reduced length of stay improves resource utilization by decreasing costs, improving inpatient bed shortages, and reducing crowding in the ER. In the study, a total of 202 patients, older than age 30, who came to the ER at the hospital of the University of Pennsylvania between October 2005 and February 2007, and whose primary complaint was chest pain, were given an electrocardiogram and a specialized CT scan. Patients who were allergic to an iodine contrast, had an abnormal heart rate, or could not take beta-blockers were excluded from the study. Patients who were admitted to the hospital were also excluded.

"We looked to determine the length of stay and times between critical points in the treatment of low-risk patients,” Dr. Agarwal explained. Patients were divided into three areas: all patients who received CT scans; patients who received the scans during 7 a.m. to 6 p.m. (ON hours) when the scans were available and 6 p.m. to 6 a.m. (OFF hours) when the scans were not available.

Results showed that patients who came into the ER during ON hours spent a total of 9 hours and 39 minutes in the department before being discharged; patients who came to the ER during OFF hours spent a total of 12 hours and 15 minutes in the unit. Patients who were referred to the CDU (clinical decision unit, which provided the CT scan, as well as additional evaluation and observation) spent 21 hours and 50 minutes in the hospital if they came during ON hours and 18 hours and 38 minutes if they came during OFF hours.

Future studies, Dr. Agarwal suggested, will look at all the expenses, including lab tests and diagnostic tests, associated with a low-risk patient's visit to the ER


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