Validation of Appropriate Use Criteria for Coronary Computed Tomographic Angiography for Chest Pain Evaluation in a Tertiary Care Emergency Room

• Published in: Journal of thoracic imaging Vol. 35; no. 3; p. 193
• Main Authors: Teressa, Getu, Manjur, Jahan, Ciuffo, Marissa, Noack, Pamela, Radulescu, Vlad A, Kanagaraj, Gautham, Ahuja, Ankur, Malaney, Roshini, Poon, Michael
• Format: Journal Article
• Language: English
• Published: United States 01.05.2020
• Subjects: Chest Pain - etiology; Computed Tomography Angiography - methods; Coronary Angiography - methods; Coronary Angiography - statistics & numerical data; Coronary Artery Disease - complications; Coronary Artery Disease - diagnostic imaging; Female; Health Resources - statistics & numerical data; Humans; Male; Middle Aged; Prospective Studies; Reproducibility of Results; Tertiary Healthcare; Unnecessary Procedures - methods; Unnecessary Procedures - statistics & numerical data
• ISSN: 1536-0237
• DOI: 10.1097/RTI.0000000000000473

Appropriate use criteria (AUC) defines the appropriateness of imaging procedures for specific clinical scenarios to promote evidence-based utilization and improve cost-effective care. The goal of this study was to assess the diagnostic yield and downstream health care resource utilization according to the AUC categorization for coronary computed tomography angiography (CCTA) in emergency department (ED) patients presenting with chest pain. A total of 789 consecutive patients in the ED with chest pain and no known coronary artery disease (CAD) who underwent CCTA were classified as appropriate, uncertain, or inappropriate use according to the 2010 AUC. We abstracted index and 30-day data from the electronic medical record to determine diagnostic yield (rate of obstructive CAD and revascularization) and health care resource utilization (downstream stress test and 30-d hospital return rate). Rates of appropriate, uncertain, and inappropriate utilization were 48.4%, 48.8%, and 2.8%. Among appropriate, uncertain, and inappropriate classifications, rates of obstructive CAD were 9%, 8%, and 32% (P=0.002); rates of revascularization were 3%, 1%, and 36% (P<0.001); downstream stress test utilization rates were 5% versus 5% versus 14% (P=0.17), and 30-day hospital return rates were 6% versus 6% versus 5% (P>0.99), respectively. Appropriate and uncertain uses were associated with low diagnostic yield compared with inappropriate use; however, our findings do not demonstrate differences between appropriate use categories with respect to downstream health care resource utilization. Further studies are needed to define the role of AUC for CCTA in the ED setting.