The NEJM is on the wagon with their recent publication. Annals of EM has been publishing all the ROMICAT trials. And, not to be outdone, the American College of Cardiology is publishing the CT-STAT trial – a head to head comparison between coronary CT angiogram in the Emergency Department and stress perfusion imaging.
The endpoint of interest, however, is length of stay – and by association total index visit costs – rather than accuracy or safety. And, in this sense, it was successful. The primary difference in LOS was the length of time it took to perform the CT or stress test, which was approximately 4 hours quicker in the CT group. ED costs were also lower, somehow, presumably billing for an observation code while awaiting the stress test and results.
However, what the authors don’t include are the total downstream costs and time of additional testing after the Emergency Department visit. The stress test group had 34 abnormal or non-diagnostic scans, while the CT group had 64. 27 patients in the stress group underwent additional testing vs. 51 in the CT group – mostly stress tests that were subsequently normal – and none of these costs or times are included in their analysis. I imagine if these extra tests are included in their analysis, the cost difference shrinks or disappears.
It seems to be a trend to advertise more than CT angiography actually delivers.
Several authors are sponsored by Siemens.
“The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) Trial”
www.ncbi.nlm.nih.gov/pubmed/21939822