The 'Triple Rule Out' CT Angiogram for Acute Chest Pain: Should it be Done, and If So, How?

被引：0
作者：
Foster T.A. [1 ]
Shapiro M.D. [1 ]
机构：
[1] Division of Cardiovascular Medicine - UHN62, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR
来源：
Current Cardiovascular Imaging Reports | 2012年 / 5卷 / 5期
关键词：
Acute chest pain; Acute coronary syndrome; Aortic dissection; Computed tomography angiography; Incidental findings; Iodinated contrast; Pulmonary embolism; Radiation; Triple rule out;
D O I：
10.1007/s12410-012-9152-6
中图分类号：
学科分类号：
摘要：
Given the large number of individuals presenting to emergency departments with acute, undifferentiated chest pain and the frequent difficulty in discerning its etiology, there has been great interest in developing techniques that can improve the initial triage of these patients. The 'Triple Rule Out CT has recently been touted as a tool to quickly assess for life threatening causes of acute chest pain, namely acute coronary syndrome, pulmonary embolism, and aortic dissection. Initial studies suggest that this protocol is safe and compares favorably with the dedicated CT protocols but at the cost of increased doses of iodinated contrast and radiation. New scanner technology has started to address these limitations but the "Triple Rule Out" CT is still in its infancy. It remains to be seen whether or not this application can ultimately improve diagnostic efficiency, cost, and/or clinical decision making. © 2012 Springer Science+Business Media, LLC.
引用
收藏
页码：310 / 317
页数：7
相关论文
共 65 条
  • [1] Pitts, S.R., Niska, R.W., Xu, J., Burt, C.W., National hospital ambulatory medical care survey: 2006 emergency department summary (2008) Natl Health Stat Rep, 7, pp. 1-38
  • [2] Swap, C.J., Nagurney, J.T., Value and limitations of chest pain history in the evaluation of patients with suspected acute coronary syndromes (2005) Jama, 294, p. 2623
  • [3] Boie, E.T., Initial evaluation of chest pain (2005) Emerg Med Clin North Am, 23, pp. 937-958
  • [4] Rogg, J.G., de Neve, J.W., Huang, C., The triple work-up for emergency department patients with acute chest pain: how often does it occur? (2011) J Emerg Med, 40, pp. 128-134
  • [5] Storrow, A.B., Gibler, W.B., Chest pain centers: diagnosis of acute coronary syndromes (2000) Ann Emerg Med, 35, pp. 449-461
  • [6] Hollander, J.E., Sease, K.L., Sparano, D.M., Effects of neural network feedback to physicians on admit/discharge decision for emergency department patients with chest pain (2004) Ann Emerg Med, 44, pp. 199-205
  • [7] Pope, J.H., Aufderheide, T.P., Ruthazer, R., Missed diagnoses of acute cardiac ischemia in the emergency department (2000) N Engl J Med, 342, pp. 1163-1170
  • [8] Christenson, J., Innes, G., McKnight, D., Safety and efficiency of emergency department assessment of chest discomfort (2004) Can Med Assoc J, 170, p. 1803
  • [9] Goodman, L.R., Curtin, J.J., Mewissen, M.W., Detection of pulmonary embolism in patients with unresolved clinical and scintigraphic diagnosis: helical CT vs angiography (1995) Am J Roentgenol, 164, pp. 1369-1374
  • [10] Kuzo, R.S., Goodman, L.R., CT evaluation of pulmonary embolism: technique and interpretation (1997) Am J Roentgenol, 169, pp. 959-965
1234567