Computed Tomography Utilization for Patients Presenting with Chest Pain

Area of Science:

• Emergency Medicine
• Radiology
• Health Services Research

Background:

• Computed tomography (CT) is a key diagnostic tool in emergency departments (EDs) for evaluating serious conditions.
• Freestanding emergency departments (FSEDs) offer an alternative to traditional hospital-based emergency departments (HBEDs).
• Understanding CT utilization patterns in different ED settings is crucial for patient care and resource allocation.

Purpose of the Study:

• To compare the utilization rates of CT scans for patients presenting with chest pain between FSEDs and HBEDs.
• To identify potential disparities in diagnostic imaging between freestanding and hospital-based emergency care.

Main Methods:

• Retrospective analysis of 67,084 patient encounters with chest pain from May 2019 to April 2021.
• Data collected from 17 emergency departments within a large integrated healthcare system.
• Multiple logistic regression used to control for patient factors (comorbidity index, ESI, age, sex, race) and assess facility type's effect on CT utilization.

Main Results:

• Patients presenting with chest pain to FSEDs were less likely to undergo CT scans compared to those in HBEDs (Adjusted Odds Ratio = 0.85, 95% CI [0.81-0.90]).
• The study controlled for significant predictive variables, isolating the impact of the facility type.
• Demographic data showed a predominantly female (55%), white (61%) patient population insured by Medicare/Medicaid (59%).

Conclusions:

• CT scans of the chest are underutilized in FSEDs relative to HBEDs for patients presenting with chest pain.
• This finding suggests a potential difference in diagnostic imaging practices between freestanding and hospital-based emergency care settings.