Impact of Technetium-99m Sestamibi Imaging on the Emergency Department Management and Costs in the Evaluation of Low-risk Chest Pain
dc.contributor.author | Kosnik, Joseph W. | en_US |
dc.contributor.author | Zalenski, Robert J. | en_US |
dc.contributor.author | Grzybowski, Mary | en_US |
dc.contributor.author | Huang, Raywin | en_US |
dc.contributor.author | Sweeny, Padraic J. | en_US |
dc.contributor.author | Welch, Robert D. | en_US |
dc.date.accessioned | 2010-06-01T20:40:47Z | |
dc.date.available | 2010-06-01T20:40:47Z | |
dc.date.issued | 2001-04 | en_US |
dc.identifier.citation | Kosnik, Joseph W.; Zalenski, Robert J.; Grzybowski, Mary; Huang, Raywin; Sweeny, Padraic J.; Welch, Robert D. (2001). "Impact of Technetium-99m Sestamibi Imaging on the Emergency Department Management and Costs in the Evaluation of Low-risk Chest Pain." Academic Emergency Medicine 8(4): 315-323. <http://hdl.handle.net/2027.42/73784> | en_US |
dc.identifier.issn | 1069-6563 | en_US |
dc.identifier.issn | 1553-2712 | en_US |
dc.identifier.uri | https://hdl.handle.net/2027.42/73784 | |
dc.identifier.uri | http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=retrieve&db=pubmed&list_uids=11282665&dopt=citation | en_US |
dc.description.abstract | Objectives: To assess the impact of rest sestamibi scanning on emergency physicians' (EPs') diagnostic certainty and decision making (as assessed by the hypothetical disposition of patients) for 69 consenting stable patients with suspected acute cardiac ischemia and nondiagnostic electrocardiograms. The resultant impact on costs was examined as a secondary outcome. Methods: Patients with suspected acute cardiac ischemia were injected with 25 mCi of sestamibi within two hours of active pain in one of three emergency department study sites. The probability of acute myocardial infarction (AMI) and unstable angina (UA), and hypothetical disposition decisions were recorded immediately before and after physicians were notified of scan results. Changes in disposition were classified as optimal or suboptimal. For the cost determinations, a cost-based decision support program was used. Results: For the subgroup found to be free of acute cardiac events (ACEs) ( n = 62), the EPs' post-sestamibi scan probabilities for AMI decreased by 11% and UA by 18% (p < 0.001 for both conditions). In seven patients with ACEs, the post-scan probabilities of AMI and UA increased, but neither was statistically significant. Scan results led to hypothetical disposition changes in 29 patients (42%), of which 27 (93%) were optimal (nine patients were reassigned to a lower level of care, two to a higher level, and 16 additional patients to “discharge-home” status). The strategy of scanning all patients who were low to moderate risk for acute cardiac ischemia would result in an increase of direct costs of care of $222 per patient evaluated, due to added cost of sestamibi scanning. Conclusions: Sestamibi scanning results appropriately affected the EPs' estimates of the probability of AMI and UA and improved disposition decisions. Scanning all low-risk patients would likely be associated with increased costs at this medical center. | en_US |
dc.format.extent | 153855 bytes | |
dc.format.extent | 3109 bytes | |
dc.format.mimetype | application/pdf | |
dc.format.mimetype | text/plain | |
dc.publisher | Blackwell Publishing Ltd | en_US |
dc.rights | 2001 Society for Academic Emergency Medicine | en_US |
dc.subject.other | Sestamibi Imaging | en_US |
dc.subject.other | Chest Pain | en_US |
dc.subject.other | Cost Evaluation | en_US |
dc.subject.other | Emergency Department | en_US |
dc.title | Impact of Technetium-99m Sestamibi Imaging on the Emergency Department Management and Costs in the Evaluation of Low-risk Chest Pain | en_US |
dc.type | Article | en_US |
dc.subject.hlbsecondlevel | Medicine (General) | en_US |
dc.subject.hlbtoplevel | Health Sciences | en_US |
dc.description.peerreviewed | Peer Reviewed | en_US |
dc.contributor.affiliationum | Department of Epidemiology, School of Public Health, University of Michigan (MG), Ann Arbor, MI. | en_US |
dc.contributor.affiliationother | Department of Emergency Medicine (JWK, RJZ, MG, RH, PJS, RDW), Wayne State University, Detroit, MI | en_US |
dc.contributor.affiliationother | Center for Healthcare Effectiveness Research (MG), Wayne State University, Detroit, MI | en_US |
dc.contributor.affiliationother | Department of Medicine, John D. Dingell Veterans Hospital (RJZ), Detroit, MI | en_US |
dc.identifier.pmid | 11282665 | en_US |
dc.description.bitstreamurl | http://deepblue.lib.umich.edu/bitstream/2027.42/73784/1/j.1553-2712.2001.tb02108.x.pdf | |
dc.identifier.doi | 10.1111/j.1553-2712.2001.tb02108.x | en_US |
dc.identifier.source | Academic Emergency Medicine | en_US |
dc.identifier.citedreference | Stussman, BJ. National Hospital Ambulatory Medical Care Survey: 1995 Emergency Department Summary. Advance data from Vital and Health Statistics of the Centers for Disease Control and Prevention/National Center for Health Statistics. 1997; 285 ;( Apr 15 ): 1 – 18. | en_US |
dc.identifier.citedreference | Gibler, WB, Lewis, LM, Erb, RE, et al. Early detection of acute myocardial infarction in patients presenting with chest pain and nondiagnostic ECGs; serial CK-MB sampling in the emergency department. Ann Emerg Med. 1990; 9: 1359 – 66. | en_US |
dc.identifier.citedreference | Gibler, WB, Young, GP, Hedges, JR, et al. Acute myocardial infarction in chest pain patients with non-diagnostic ECGs: serial CK-MB sampling in the emergency department. Ann Emerg Med. 1992; 21: 504 – 12. | en_US |
dc.identifier.citedreference | Weingarten, SR, Ermann, B, Riedinger, MS, Shah, PK, Ellrodt, AG. Selecting the best triage rule for patients hospitalized with chest pain. Am J Med. 1989; 87: 494 – 500. | en_US |
dc.identifier.citedreference | Roberts, R, Kleiman, NS Earlier diagnosis and treatment of acute myocardial infarction necessitates the need for a “new diagnostic mind-set.” Circulation. 1994; 89: 872 – 81. | en_US |
dc.identifier.citedreference | Goldman, L, Cook, EF, Brand, DA, et al. A computer protocol to predict myocardial infarction in emergency department patients with chest pain. N Engl J Med. 1988; 318: 797 – 803. | en_US |
dc.identifier.citedreference | Pozen, MW, D'Agostin, RB, Mitchell, JB, et al. The usefulness of a predictive instrument to reduce inappropriate admission to the coronary care unit. Ann Intern Med. 1980; 92: 238 – 42. | en_US |
dc.identifier.citedreference | Selker, HP, Griffith, JL, Patil, S, Long, WJ, D'Agostino, RB. A comparison of performance of mathematical predictive methods for medical diagnosis: identifying acute cardiac ischemia among emergency department patients. J Invest Med. 1995; 43: 468 – 76. | en_US |
dc.identifier.citedreference | Puleo, PR, Meyer, D, Wathen, C, et al. Use of a rapid assay of subforms of creatine kinase MB to diagnose or rule out acute myocardial infarction. N Engl J Med. 1994; 331: 561 – 6. | en_US |
dc.identifier.citedreference | Gibler, WB, Runyon, JP, Levy, RC, et al. A rapid diagnostic and treatment center for patients with chest pain in the emergency department. Ann Emerg Med. 1995; 25: 1 – 8. | en_US |
dc.identifier.citedreference | Horowitz, RS, Morganroth, J, Parrotto, C, et al. Immediate diagnosis of acute myocardial infarction by two-dimensional echocardiography. Circulation 1982; 65: 323 – 9. | en_US |
dc.identifier.citedreference | Varetto, T, Cantalupi, D, Altieri, A, Orlandi, C. Emergency room technetium-99m sestamibi imaging to rule out acute myocardial ischemic events in patients with nondiagnostic electrocardiography. J Am Coll Cardiol. 1993; 22: 1804 – 8. | en_US |
dc.identifier.citedreference | Hilton, T, Thompson, R, Williams, H, et al. Technetium-99m sestamibi myocardial perfusion imaging in the emergency room evaluation of chest pain. J Am Coll Cardiol. 1994; 23: 1016 – 22. | en_US |
dc.identifier.citedreference | Kontos, MC, Jesse, RL, Schmidt, KL, Ornato, JP, Tatum, JL. Value of acute rest sestamibi perfusion imaging for evaluation of patients admitted to the emergency department with chest pain. J Am Coll Cardiol. 1997; 30: 976 – 82. | en_US |
dc.identifier.citedreference | Tatum, JL, Jesse, RL, Kontos, MC, et al. Comprehensive strategy for the evaluation and triage of the chest pain patient. Ann Emerg Med. 1997; 29: 116 – 25. | en_US |
dc.identifier.citedreference | Kosnik, JW, Zalenski, RJ, Shamsa, F, et al. Resting sestamibi imaging for the prognosis of low risk chest pain. Acad Emerg Med. 1999; 6: 998 – 1004. | en_US |
dc.identifier.citedreference | Selker, HP, Griffith, FL, D'Agostino, RD. A tool for judging coronary care unit admission appropriateness, valid for both real-time and retrospective use: a time-insensitive predictive instrument (ACI-TIPI) for acute cardiac ischemia: a multicenter study. Med Care. 1991; 29: 610 – 27. | en_US |
dc.identifier.citedreference | Mikhail, MG, Smith, FA, Gray, M, Britton, C, Frederiksen, SM. Cost—effectiveness of mandatory stress testing in chest pain center patients. Ann Emerg Med. 1997; 29: 88 – 98. | en_US |
dc.identifier.citedreference | Neter, J, Wasserman, W, Kutner, MH. Applied Linear Statistical Models: Regression, Analysis of Variance, and Experimental Designs, 2nd edition. Homewood, IL: Irwin, Inc., 1985. | en_US |
dc.identifier.citedreference | Weissman, IA, Dickinson, CZ, Dworkin, HJ, O'Neill, WW, Junie, JE. Cost—effectiveness of myocardial perfusion imaging with SPECT in the emergency department evaluation of patients with unexplained chest pain. Radiology. 1996; 199: 353 – 7. | en_US |
dc.identifier.citedreference | Radensky, PW, Hilton, TC, Fulmer, H, McLaughlin, BA, Stowers, SA. Potential cost—effectiveness of initial myocardial perfusion imaging for assessment of emergency department patients with chest pain. Am J Cardiol. 1997; 79: 595 – 9. | en_US |
dc.identifier.citedreference | Heller, GV, Stowers, SA, Hendel, RC, et al. Clinical value of acute rest technetium-99m tetrofosmin tomographic myocardial perfusion imaging in patients with acute chest pain and nondiagnostic electrocardiograms. J Am Coll Cardiol. 1998; 31: 1011 – 7. | en_US |
dc.owningcollname | Interdisciplinary and Peer-Reviewed |
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