Outcomes and Radiation Exposure of Emergency Department Patients With Chest Pain and Shortness of Breath and Ultra low Pretest Probability: A Multicenter Study
Outcomes and Radiation Exposure of Emergency Department Patients With Chest Pain and Shortness of Breath and Ultra low Pretest Probability: A Multicenter Study
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DOI：
10.1016/j.annemergmed.2013.09.009
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发表时间：
2014-03-01
影响因子：
6.2
通讯作者：
Nelson, R. Darrell
中科院分区：
文献类型：
--
作者：
Kline, Jeffrey A.;Shapiro, Nathan I.;Nelson, R. Darrell
研究目的：过度辐射暴露仍然是急性冠脉综合征和肺栓塞患者的一个问题，但必须从预试验概率和结局的角度进行判断。我们量化和定性的预测试概率，结果，和辐射暴露的成年人都胸痛和呼吸困难。方法：这是一个前瞻性，4中心，结果研究。患者为成人，有呼吸困难和胸痛，非诊断性ECG，无明显诊断。采用经验证的方法评估急性冠状动脉综合征和肺栓塞的预测概率;超低风险定义为急性冠状动脉综合征和肺栓塞的预测概率均小于2.5%。患者随访诊断和总的医疗辐射暴露为90 day.Results：840例患者有完整的数据，23例（3%）有急性冠状动脉综合征和15例（2%）有肺栓塞。该队列接受了平均4.9 mSv的胸部辐射，48%来自计算机断层扫描肺血管造影。在227例患者（27%）中，急性冠脉综合征和肺栓塞的预检验概率估计值小于2.5%，其中0/277例（0%; 95%置信区间0%至1.7%）患有急性冠脉综合征或肺栓塞，7/227例（3%）有任何重要的心肺诊断。在这个超低风险组中，每例患者的估计胸部辐射暴露为3.5毫希沃特，其中26（3%）大于5毫希沃特辐射到胸部，没有显着的心肺diagnosis.Conclusion：四分之一的胸痛和呼吸困难的患者有超低风险，没有急性冠脉综合征或肺栓塞，但暴露于平均3.5毫希沃特辐射到胸部。这些数据可用于临床指南，以减少辐射暴露。
Study objective: Excessive radiation exposure remains a concern for patients with symptoms suggesting acute coronary syndrome and pulmonary embolism but must be judged in the perspective of pretest probability and outcomes. We quantify and qualify the pretest probability, outcomes, and radiation exposure of adults with both chest pain and dyspnea.Methods: This was a prospective, 4-center, outcomes study. Patients were adults with dyspnea and chest pain, nondiagnostic ECGs, and no obvious diagnosis. Pretest probability for both acute coronary syndrome and pulmonary embolism was assessed with a validated method; ultralow risk was defined as pretest probability less than 2.5% for both acute coronary syndrome and pulmonary embolism. Patients were followed for diagnosis and total medical radiation exposure for 90 days.Results: Eight hundred forty patients had complete data; 23 (3%) had acute coronary syndrome and 15 (2%) had pulmonary embolism. The cohort received an average of 4.9 mSv radiation to the chest, 48% from computed tomography pulmonary angiography. The pretest probability estimates for acute coronary syndrome and pulmonary embolism were less than 2.5% in 227 patients (27%), of whom 0 of 277 (0%; 95% confidence interval 0% to 1.7%) had acute coronary syndrome or pulmonary embolism and 7 of 227(3%) had any significant cardiopulmonary diagnosis. The estimated chest radiation exposure per patient in this ultralow-risk group was 3.5 mSv, including 26 (3%) with greater than 5 mSv radiation to the chest and no significant cardiopulmonary diagnosis.Conclusion: One quarter of patients with chest pain and dyspnea had ultralow risk and no acute coronary syndrome or pulmonary embolism but were exposed to an average of 3.5 mSv radiation to the chest. These data can be used in a clinical guideline to reduce radiation exposure.