The Triple Work-Up for Emergency Department Patients with Acute Chest Pain: How Often does It Occur?

Rogg, Jonathan G.; Neve, Jan‐Walter De; Huang, Calvin; Brown, David F.M.; Jang, Ik–Kyung; Chang, Yuchiao; Marill, Keith A.; Parry, Blair A.; Hoffmann, Udo; Nagurney, John Tobias

doi:10.1016/j.jemermed.2008.02.031

Cited by 18 publications

(12 citation statements)

References 43 publications

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“…In fact, approximately 20% of ED patients who are evaluated for acute chest pain receive simultaneous testing for both VTE and acute coronary syndromes. 21 Here, we found that the incidence of CIN (14%) remains much higher than would be anticipated from that observed among patients undergoing cardiac catheterization for acute chest pain, and remains comparable to the rate observed in retrospective studies. 7,8 Among the indications for CECT, there are very few equivalent or near-equivalent diagnostic imaging alternatives that avoid iodinated contrast exposure, particularly in the ED setting.…”

Section: Discussionsupporting

confidence: 78%

19: Prospective Study of the Incidence of Contrast-Induced Nephropathy Among Patients Evaluated for Pulmonary Embolism by Contrast-Enhanced Computed Tomography

Mitchell

Jones

Tumlin

et al. 2010

Annals of Emergency Medicine

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Section: Discussionsupporting

confidence: 78%

19: Prospective Study of the Incidence of Contrast-Induced Nephropathy Among Patients Evaluated for Pulmonary Embolism by Contrast-Enhanced Computed Tomography

Mitchell

Jones

Tumlin

et al. 2010

Annals of Emergency Medicine

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“…Cardiac CTA has proved to be an effective tool to rule out coronary artery disease (CAD), with a sensitivity of 93-99% and negative predictive value of 95-99% [23]. About 20% of patients with acute chest pain present to the ED with atypical acute chest pain and often require multiple examinations to exclude PE and/or AAS, in addition to excluding obstructive CAD [24]. …”

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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“…Of these, diagnostic tests for ACS and PE and ACS and AAS were necessary in 19.3% (n ¼ 121/626) and 2.2% (n ¼ 14/626), respectively (25). However, the clinical situation in which ACS, AAS, and PE would need to be simultaneously excluded is rare (i.e.…”

Section: Discussionmentioning

confidence: 99%

Rarity of isolated pulmonary embolism and acute aortic syndrome occurring outside of the field of view of dedicated coronary CT angiography

et al. 2011

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The Triple Work-Up for Emergency Department Patients with Acute Chest Pain: How Often does It Occur?

Cited by 18 publications

References 43 publications

19: Prospective Study of the Incidence of Contrast-Induced Nephropathy Among Patients Evaluated for Pulmonary Embolism by Contrast-Enhanced Computed Tomography

19: Prospective Study of the Incidence of Contrast-Induced Nephropathy Among Patients Evaluated for Pulmonary Embolism by Contrast-Enhanced Computed Tomography

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

Rarity of isolated pulmonary embolism and acute aortic syndrome occurring outside of the field of view of dedicated coronary CT angiography

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