scholarly journals Cost-effectiveness of Quantitative Pretest Probability Intended to Reduce Unnecessary Medical Radiation Exposure in Emergency Department Patients With Chest Pain and Dyspnea

2015 ◽  
Vol 22 (5) ◽  
pp. 525-535 ◽  
Author(s):  
Jennifer L. Troyer ◽  
Alan E. Jones ◽  
Nathan I. Shapiro ◽  
Alice M. Mitchell ◽  
Ian Hewer ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cost Effectiveness ◽  
Chest Pain ◽  
Radiation Exposure ◽  
Pretest Probability ◽  
Medical Radiation ◽  
Emergency Department Patients ◽  
Medical Radiation Exposure

Reproductive Effects of Low-to-Moderate Medical Radiation Exposure

2012 ◽  
Vol 19 (36) ◽  
pp. 6171-6177 ◽  
Author(s):  
G. Latini ◽  
L. Dipaola ◽  
A. Mantovani ◽  
E. Picano
Keyword(s):  
Radiation Exposure ◽  
Reproductive Effects ◽  
Medical Radiation ◽  
Medical Radiation Exposure

scholarly journals 2015 ACR/ACC/AHA/AATS/ACEP/ASNC/NASCI/SAEM/SCCT/SCMR/SCPC/SNMMI/STR/STS Appropriate Utilization of Cardiovascular Imaging in Emergency Department Patients With Chest Pain

2016 ◽  
Vol 67 (7) ◽  
pp. 853-879 ◽  
Author(s):  
Frank J. Rybicki ◽  
James E. Udelson ◽  
W. Frank Peacock ◽  
Samuel Z. Goldhaber ◽  
Eric M. Isselbacher ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Cardiovascular Imaging ◽  
Emergency Department Patients

Abstract 16592: The Diamond-Forrester Criterion Significantly Overestimates the Risk of Obstructive Coronary Artery Disease in Patients Presenting to the Emergency Department With Low-Risk Chest Pain

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Todd Lecher ◽  
William R Davidson ◽  
Andrew Foy
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Chest Pain ◽  
Stress Echocardiography ◽  
Stress Test ◽  
Pretest Probability ◽  
Low Risk ◽  
High Cholesterol ◽  
Observation Unit ◽  
Diamond Forrester

Introduction: We sought to (1) classify patients who underwent stress echocardiography in an emergency department observation unit based on their pretest probabilities of obstructive CAD using the Diamond-Forrester criterion, (2) to compare observed versus expected frequencies of obstructive CAD based on the Diamond-Forrester risk categories of low (<25%), intermediate (25-75%), and high (>75%) pretest probability of disease, and (3) to test the association of traditional cardiovascular risk factors (age, gender, hypertension, diabetes, high cholesterol, and smoking) with obstructive CAD. METHODS: Retrospective review of the electronic medical record for patients who presented to the emergency department with chest pain and underwent observation followed by stress echocardiography between the period January 1, 2012 to December 31, 2012. Patients were classified as low, intermediate, or high risk for obstructive CAD using the Diamond-Forrester criterion. Main outcome measures were stress echocardiography results as well as receipt of cardiac catheterization and results. RESULTS: A total of 504 patients were included in the final analysis. Overall, 4.8% had a positive stress test and only 1.2% had angiographic evidence of obstructive CAD. In each category of risk, the observed frequency of obstructive CAD was significantly lower than expected. Having a high pretest probability as defined by the Diamond-Forrester criterion was significantly associated with obstructive CAD. Age, gender, diabetes, hypertension, high cholesterol, and smoking were not independently associated with evidence of obstructive CAD; nor were any composites of these risk factors. CONCLUSIONS: The traditional Diamond-Forrester criterion significantly overestimates the probability of obstructive CAD in ED observation unit patients. Reliance on the Diamond-Forrester criterion and other traditional risk factors associated with obstructive CAD in the outpatient setting could lead to faulty Bayesian reasoning, overuse of non-invasive imaging, and improper interpretation of test results in an ED population of low-risk chest pain patients. Further work is required to determine an optimal risk-assessment strategy for this patient population.

Development of a Clinical Prediction Rule for 30-Day Cardiac Events in Emergency Department Patients With Chest Pain and Possible Acute Coronary Syndrome

2012 ◽  
Vol 59 (2) ◽  
pp. 115-125.e1 ◽  
Author(s):  
Erik P. Hess ◽  
Robert J. Brison ◽  
Jeffrey J. Perry ◽  
Lisa A. Calder ◽  
Venkatesh Thiruganasambandamoorthy ◽  
...  
Keyword(s):  
Emergency Department ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Clinical Prediction ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
Emergency Department Patients
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