Using a web-based tool that calculates the probability of acute coronary syndrome (ACS) and pulmonary embolism (PE) in patients presenting at emergency departments with chest pain and shortness of breath can reduce treatment costs and patient radiation exposure, according to a study published online last week in Circulation: Cardiovascular Imaging.
The researchers tested the idea that physicians, if informed that there was a low possibility of a patients developing ACS or PE, would decide on a treatment course that would lower costs and reduce patient radiation exposure without increasing the possibility of adverse events, hospital readmission or delayed diagnosis.
The research was led by Jeffrey Kline, M.D., of Indiana University School of Medicine. First, in order to test the accuracy of a web-based probability tool, the researchers investigated patients who presented at the ED with chest pain and shortness of breath, and had received non-diagnostic electrocardiograms that were negative for ischemia and infarction. The web-based probability tool was developed with 17 predictor variables and clinicians were randomized into two groups: one group which received the probability estimates, and the other group (the control group) which received no estimate.
Physicians receiving the probability estimates ended up recommending treatments that reduced patient radiation exposure. Patients in the intervention group received an average of 0.06 mSv to the chest, compared to 0.34 mSv to patients in the control group. Treatment costs also were reduced ($934 for the patients in the intervention group, compared to $1,275 in the control group).
Despite the apparent benefits of this kind of approach to treating chest pain symptoms, the authors suggested that several factors may work against its widespread use.
"For patients with chest pain and dyspnea, the remote possibility of failing to diagnose acute coronary syndrome or pulmonary embolism, and the specter of the patient's death, and concern for possible allegation of negligence, compels many emergency clinicians in the U.S. to order diagnostic tests at exceedingly low pretest probabilities," the authors wrote, as reported in an article in Cardiovascular Business.
According to research published in the Journal of the American College of Radiology in July, use of an appropriate use criteria decision support tool helped to eliminate inappropriate imaging examinations to evaluate coronary artery disease.