New guidelines, published online Jan. 22 in the Journal of the American College of Cardiology, have been developed for assessing the appropriateness of imaging for patients presenting to the emergency department with chest pain.
Frank J. Rybicki, M.D., Ph.D., from the Ottawa Hospital in Canada, and colleagues representing emergency medicine, cardiology, and radiology specialties discuss appropriate use of imaging in emergency department patients presenting with chest pain, which accounts for 5.4 percent of emergency department visits.
The researchers rated the appropriateness of imaging for each of 20 clinical scenarios on a 1 to 9 scale, which classified imaging as rarely appropriate, may be appropriate, and appropriate. Appropriateness balanced the risks and benefits of imaging in the context of an individual patient. The clinical scenarios were grouped from four key clinical entry points that direct imaging: suspected non-ST-segment elevation acute coronary syndromes; suspected pulmonary embolism; suspected acute syndrome of the aorta; and patients for whom a leading diagnosis is problematic or not possible.
“This document captures a wide scope of those patients who come to the emergency department with chest pain, although there will always be patients who present unique situations and no document can be a substitute for clinical judgment,” Rybicki said in a statement.