Use of MSCT Scanning in the Emergency-Room Evaluation of Patients with Chest Pain
Acute chest pain is one of the most frequent symptoms reported by patients evaluated in emergency departments. Annually, about 6 million people with acute chest pain visit emergency rooms (ERs) throughout the USA. Diagnosis of an acute coronary syndrome (ACS) is often difficult: studies have suggested that 2–6% of patients with an ACS are inappropriately sent home from the ER, leading to increased morbidity and mortality. This is also an increasing motive for malpractice claims. Protocols for the evaluation of ACS patients include ECG and assessment of markers of myocardial damage (including CK-MB and troponin). Unfortunately, there is a minority of patients with normal ECG and cardiac enzymes at admission who still have ACS. These patients require a time-consuming and expensive protocol, with serial ECG and cardiac-enzyme assessments. Patients with persistently negative results often undergo a stress test, while sometimes additional tests are also performed to rule out other, possibly fatal causes of chest pain (including aortic dissection and lung embolism). Yet, mistakes are still possible even after this complex protocol, which has an estimated annual cost of $10–13 billion in the USA alone. Finally, a large number of patients with no serious disease are held for many hours in the ER, leading to overwork, the need for larger staff, and longer waiting times for other ER patients.
KeywordsAcute Coronary Syndrome Aortic Dissection Coronary Disease Acute Coronary Syndrome Patient Acute Chest Pain
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