Reduction in observation unit length of stay with coronary computed tomography angiography depends on time of emergency department presentation.
Reduction in observation unit length of stay with coronary computed tomography angiography depends on time of emergency department presentation.
复制标题
冠状动脉计算机断层扫描血管造影观察单位住院时间的减少取决于急诊科就诊的时间。
DOI：
10.1111/acem.12094
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Miller,ChadwickD
中科院分区：
文献类型：
--
作者：
Mahler,SimonA;Hiestand,BrianC;Nwanaji-Enwerem,Jamaji;Goff,DavidC;Burke,GregoryL;DouglasCase,L;Nicks,Bret;Miller,ChadwickD
ObjectivesPrior studies demonstrating shorter length of stay (LOS) from coronary computed tomography angiography (CCTA) relative to stress testing in emergency department (ED) patients have not considered time of patient presentation. The objectives of this study were to determine whether low‐risk chest pain patients receiving stress testing or CCTA have differences in ED plus observation unit (OU) LOS and if there are disparities in testing modality use, based on the time of patient presentation to the ED.MethodsThe authors examined a cohort of low‐risk chest pain patients evaluated in an ED‐based OU using prospective and retrospective OU registry data. During the study period, stress testing and CCTA were both available from 08:00 to 17:00 hours. CCTA was not available on weekends, and therefore only subjects presenting on weekdays were included. Cox regression analysis was used to model the effect of testing modality (stress testing vs. CCTA) on OU LOS. Separate models were fit based on time of patient presentation to the ED using 4‐hour blocks beginning at midnight. The primary independent variable was testing modality: stress testing or CCTA. Age, sex, and race were included as covariates. Logistic regression was used to model testing modality choice by time period adjusted for age, sex, and race.ResultsOver the study period, 841 subjects presented Monday through Friday. Median LOS was 18.0 hours (interquartile range [IQR] = 11.7 to 22.9 hours). Objective cardiac testing was completed in 788 of 841 (94%) patients, with 496 (63%) receiving stress testing and 292 (37%) receiving CCTA. After age, race, and sex were adjusted for, patients presenting between 08:00 and 11:59 hours not only had a shorter LOS associated with CCTA (p < 0.0001), but also had a greater likelihood of being tested by CCTA (p = 0.001). None of the other time periods had significant differences in LOS or testing modality choice for CCTA relative to stress testing.ConclusionsIn an OU setting with weekday and standard business hours CCTA availability, CCTA testing was associated with shorter LOS among low‐risk chest pain patients only in patients presenting to the ED between 08:00 and 11:59 hours. That time period was also associated with a greater likelihood of being tested by CCTA, suggesting that ED providers may have intuited the inability of CCTA to shorten LOS during other times.
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ACCF/ASE/ACEP/AHA/ASNC/SCAI/SCCT/SCMR 2008 年负荷超声心动图适宜性标准：美国心脏病学会基金会适宜性标准工作组、美国超声心动图学会、美国急诊医师学会、美国心脏协会的报告
影响因子：
24
作者：
P. Douglas;B. Khandheria;R. Stainback;N. Weissman;E. Peterson;R. Hendel;M. Blaivas;Roger D. Des Prez;L. Gillam;T. Golash;L. Hiratzka;W. Kussmaul;A. Labovitz;J. Lindenfeld;F. Masoudi;P. Mayo;D. Porembka;J. Spertus;L. Wann;S. Wiegers;R. Brindis;M. Patel;M. Wolk;Joseph M. Allen
通讯作者：
Joseph M. Allen
ACCF 2008 年多模态无创心血管成像培训声明 美国心脏病学会基金会/美国心脏协会/美国医师学会临床能力和培训工作组与美国心脏病学会合作制定的报告
影响因子：
24
作者：
James D. Thomas;W. Zoghbi;G. Beller;R. Bonow;M. Budoff;M. Cerqueira;M. Creager;P. Douglas;V. Fuster;Mario J. Garcia;D. Holmes;W. Manning;G. Pohost;T. Ryan;W. V. Van Decker;S. Wiegers
通讯作者：
S. Wiegers
影响因子：
24
作者：
Hoffmann, Udo;Bamberg, Fabian;Chae, Claudia U.;Nichols, John H.;Rogers, Ian S.;Seneviratne, Sujith K.;Truong, Quynh A.;Cury, Ricardo C.;Abbara, Suhny;Shapiro, Michael D.;Moloo, Jamaluddin;Butler, Javed;Ferencik, Maros;Lee, Hang;Jang, Ik-Kyung;Parry, Blair A.;Brown, David F.;Udelson, James E.;Achenbach, Stephan;Brady, Thomas J.;Nagurney, John T.
通讯作者：
Nagurney, John T.
%20%2025%%20至%2050%%20冠状%20狭窄%20与%20心脏%20计算%20断层扫描%20血管造影%20在%20ED%20患者中的意义。
影响因子：
3.6
作者：
Chadwick D Miller;H. Litt;K. Askew;D. Entrikin;J. Carr;A. Chang;J. Kilkenny;Benjamin M. Weisenthal;J. Hollander
通讯作者：
J. Hollander
影响因子：
24
作者：
Goldstein, James A.;Gallagher, Michael J.;Raff, Gilbert L.
通讯作者：
Raff, Gilbert L.