Triple Rule Out CT in the Emergency Department: Clinical Risk and Outcomes (Triple Rule Out in the Emergency...

Area of Science:

• Radiology and Imaging
• Cardiology
• Emergency Medicine

Background:

• Triple rule out CT protocols (TRO-CT) are proposed for simultaneous evaluation of acute chest pain causes: acute myocardial infarction (MI), acute pulmonary embolism (PE), and acute aortic syndrome.
• Current guidelines suggest tailoring CT protocols to the most likely diagnosis, leaving the optimal patient population for TRO-CT unclear.

Purpose of the Study:

• To evaluate the utility of TRO-CT in emergency department (ED) patients presenting with acute chest pain.
• To assess the clinical overlap and outcomes associated with TRO-CT in patients at risk for MI, PE, and acute aortic syndrome.

Main Methods:

• Retrospective review of TRO-CT scans performed in the ED from April 2021 to April 2022.
• Clinical risk for MI, PE, and acute aortic syndrome was calculated using HEART, PERC, and ADD-RS scores.
• TRO-CT findings and 30-day clinical outcomes were analyzed.

Main Results:

• 1279 patients were included; 65.0% were at risk for two or more conditions.
• TRO-CT identified obstructive coronary artery disease (CAD) in 29.8%, acute PE in 7.1%, and acute aortic syndrome in 0.5%.
• At 30-day follow-up, acute MI was diagnosed in 2.2%, acute PE in 7.0%, and acute aortic syndrome in 0.5% of patients.

Conclusions:

• A high clinical overlap exists in the presentation of acute MI, PE, and acute aortic syndrome based on clinical risk scores.
• Further studies are needed to compare TRO-CT algorithms with standard-of-care protocols for ED patients.