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RANDOMIZED COST COMPARISON OF CARDIAC MRI USE IN EMERGENCY DEPARTMENT PATIENTS WITH CHEST PAIN

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abstract
Objective To compare the medical cost among patients with intermediate-risk chest pain managed with two diagnostic strategies: an observation unit (OU) cardiac MRI (CMR) strategy and inpatient care. Methods A single center clinical trial randomized 110 patients with intermediate-risk chest pain (TIMI ≥2 or clinical impression) to OU CMR (OU care, serial cardiac markers and stress CMR) or inpatient care (admission, care determined by the admitting provider). Outcomes included direct cost of the index hospital visit and correct cardiac dispositions. Results 53 subjects were randomized to OU CMR and 57 to inpatient care; In the OU CMR group, 49/53 underwent stress CMR, 11/53 were admitted, 1 left against medical advice (AMA), and 41 were discharged. Of inpatient care participants, 54/57 were admitted and 3 left AMA. ACS occurred in 2 patients in the OU CMR group and 6 in the inpatient care group. At 30 days no subjects experienced ACS after discharge. OU CMR was associated with reduced median index hospitalization cost ($2062 vs $2680, p<0.001). OU CMR improved cardiac disposition decisions (83% vs 11%, p<0.001). Conclusion In patients with intermediate-risk chest pain, an OU CMR strategy reduces cost and improves cardiac disposition decisions with similar outcomes at 30 days.
subject
Costs and Cost Analysis
Chest Pain
Magnetic Resonance Imaging
Clinical Trial
Emergency Medicine
contributor
Miller, Chadwick (author)
Herrington, David (committee chair)
Hwang, Wenke (committee member)
Hoekstra, James (committee member)
Case, Doug (committee member)
Hundley, W. Gregory (committee member)
date
2009-08-11T15:42:31Z (accessioned)
2010-06-18T18:58:32Z (accessioned)
2009-08-11T15:42:31Z (available)
2010-06-18T18:58:32Z (available)
2009-08-11T15:42:31Z (issued)
degree
Clinical Epidemiology & Health Services (discipline)
identifier
http://hdl.handle.net/10339/14773 (uri)
language
en_US (iso)
publisher
Wake Forest University
rights
Release the entire work for access only to the Wake Forest University system for one year from the date below. After one year, release the entire work for access worldwide. (accessRights)
title
RANDOMIZED COST COMPARISON OF CARDIAC MRI USE IN EMERGENCY DEPARTMENT PATIENTS WITH CHEST PAIN
type
Thesis

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