Photo Credit: Egor Kulinich

The following is a summary of “Triple Rule Out CT in the Emergency Department: Clinical Risk and Outcomes (Triple Rule Out in the Emergency Department),” published in the December 2024 issue of Pulmonology by Araoz et al. 

Researchers conducted a retrospective study to evaluate patient populations that would benefit from triple rule out CT protocols (TRO-CT) for acute chest pain, as current guidelines recommend tailoring CT protocols to the most likely diagnosis.  

They reviewed TRO-CT scans performed at the Emergency Department (ED) of the institution from April 2021 to April 2022. Clinical risk for myocardial infarction (MI), pulmonary embolism (PE), and acute aortic syndrome was assessed using established clinical scoring systems, including the HEART score, PERC score, and ADD-RS. The findings from TRO-CT scans and 30-day clinical outcomes were extracted through chart review.  

The results showed 1,279 patients were included in the analysis, with 831 (65.0%) identified as at-risk for 2 or more clinical conditions. Among the patients, 381 (29.8%) had obstructive coronary artery disease (CAD), 91 (7.1%) had acute pulmonary embolism (PE), and 7 (0.5%) had acute aortic syndrome. At the 30-day follow-up, 28 patients (2.2%) were diagnosed with acute MI (95% CI: 1.5-3.2%), 90 patients (7.0%) with acute PE (95% CI: 5.7-8.6%), and 7 patients (0.5%) with acute aortic syndrome (95% CI: 0.2-1.2%). A low-risk HEART score was linked to a 0.3% diagnosis of MI at 30 days (95% CI: 0.0-1.6%), low-risk PERC score to a 2.9% diagnosis of PE (95% CI: 0.7-8.7%), and low-risk ADD-RS to a 0.3% diagnosis of acute aortic syndrome (95% CI: 0.0-1.8%).  

Investigators concluded a significant clinical overlap in the presentation of acute MI, acute PE, and acute aortic syndrome based on clinical risk scores, and further studies were needed to compare a TRO-CT algorithm with standard-of-care algorithms in patients admitted to ED. 

Source: pubmed.ncbi.nlm.nih.gov/39658473