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Cost-effectiveness of routine coagulation testing in the evaluation of chest pain in the ED

Erik Kochert1, Lawrence Goldhahn, Ian Hughes

  • 1Department of Emergency Medicine, York Hospital, York, Pennsylvania, USA. ekochert@wellspan.org

The American Journal of Emergency Medicine
|July 17, 2012
PubMed

Insights

Routine coagulation testing for chest pain patients in the emergency department (ED) is not cost-effective. This practice should be avoided to reduce unnecessary healthcare costs and improve resource allocation.

Area of Science:

  • Emergency Medicine
  • Clinical Pathology
  • Health Economics

Background:

  • Chest pain accounts for approximately 5% of US emergency department (ED) visits.
  • Coagulation testing is frequently performed during the ED evaluation of chest pain patients.

Purpose of the Study:

  • To assess the cost-effectiveness of routine coagulation testing for patients presenting with chest pain in the ED.

Main Methods:

  • Retrospective chart review of 740 patients evaluated for chest pain in a community ED.
  • Analysis of coagulation studies ordered, appropriateness of testing, and clinical interventions based on results.
  • Defined appropriate testing indications including cirrhosis, known coagulopathy, active bleeding, warfarin use, or ST-elevation myocardial infarction.

Main Results:

  • Coagulation studies were ordered in 55% of patients (406/740).
  • 81% of tested patients (327/406) lacked indications for testing.
  • No patients tested without indication required therapeutic intervention, despite one case of clinically significant coagulopathy.

Conclusions:

  • Routine coagulation testing in ED chest pain patients is not cost-effective.
  • Discontinuation of routine coagulation testing for this patient population is recommended.
Abstract

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