Issn Print: 1535-282X

Publication Date: 2002/12/01


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The Use of Electron Beam Computed Tomography (EBCT) in the Evaluation of Chest Pain in Emergency Department (ED) Observation Units

D. A. Laudon; T. R. Behrenbeck; L. F. Vokov; P. F. Sheedy; J. F. Breen

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Excerpt

Background: The presence of coronary artery calcification (CAC) by EBCT has been shown to be highly predictive of CAD while the absence of CAC is highly specific for the absence of significant CAD. We reported earlier that chest pain patients presenting to the ED with normal cardiac markers and ECGs, and with no prior cardiac history could be safely dismissed based on a negative EBCT done in the ED. This study evaluated the use of EBCT in an ED observation unit.
Methods: A prospective substudy of chest pain patients evaluated in our ED observation unit who underwent an EBCT as part of a study protocol. Random sampling was done of men 30-55 years of age and women 40-65 years of age.
Results: 123 chest pain patients evaluated in our observation unit underwent CAC scanning by EBCT. Ninety two patients (75%) had uneventful observation periods, negative cardiac stress tests and were discharged home from the observation unit. Thirty one patients (25%) were admitted to the hospital with recurrence of chest pain, elevated markers or positive cardiac stress tests. Fifty five patients (60%) of the 92 patients discharged from the ED observation unit had negative EBCTs for CAC. One year follow-up showed no cardiac events in these patients. Based on their negative EBCTs, 60% of the observation patients ultimately discharged from the observation unit or 45% of all patients placed into the observation unit could have been dismissed sooner from the observation unit, not required provocative cardiac testing and thus required less resource utilization.
Conclusion: EBCT has a role in the evaluation of chest pain patients in observation units.
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