BACKGROUND: Several large trials have evaluated the effect of CT screening based on specific symptoms, with varying outcomes. Screening of patients with CT based on their prognosis alone has not been examined before. For moderate-to-high risk patients presenting in the emergency department (ED), the potential gain from a CT scan might outweigh the risk of radiation exposure. We hypothesized that an accelerated "multiple rule out" CT screening of moderate-to-high risk patients will detect many clinically unrecognized diagnoses that affect change in treatment. METHOD: Patients ≥ 40 years, triaged as high-risk or moderate-to-high risk according to vital signs, were eligible for inclusion. Patients were scanned with a combined ECG-gated and dual energy CT scan of cerebrum, thorax, and abdomen. The impact of the CT scan on patient diagnosis and treatment was examined prospectively by an expert panel. RESULTS: A total of 100 patients were included in the study, (53% female, mean age 73 years [age range, 43-93]). The scan lead to change in treatment or additional examinations in 37 (37%) patients, of which 24 (24%) were diagnostically significant, change in acute treatment in 11 (11%) cases and previously unrecognized malignant tumors in 10 (10%) cases. The mean size specific radiation dose was 15.9 mSv (± 3.1 mSv). CONCLUSION: Screening with a multi-rule out CT scan of high-risk patients in an ED is feasible and result in discovery of clinically unrecognized diagnoses and malignant tumors, but at the cost of radiation exposure and downstream examinations. The clinical impact of these findings should be evaluated in a larger randomized cohort.
BACKGROUND: Several large trials have evaluated the effect of CT screening based on specific symptoms, with varying outcomes. Screening of patients with CT based on their prognosis alone has not been examined before. For moderate-to-high risk patients presenting in the emergency department (ED), the potential gain from a CT scan might outweigh the risk of radiation exposure. We hypothesized that an accelerated "multiple rule out" CT screening of moderate-to-high risk patients will detect many clinically unrecognized diagnoses that affect change in treatment. METHOD:Patients ≥ 40 years, triaged as high-risk or moderate-to-high risk according to vital signs, were eligible for inclusion. Patients were scanned with a combined ECG-gated and dual energy CT scan of cerebrum, thorax, and abdomen. The impact of the CT scan on patient diagnosis and treatment was examined prospectively by an expert panel. RESULTS: A total of 100 patients were included in the study, (53% female, mean age 73 years [age range, 43-93]). The scan lead to change in treatment or additional examinations in 37 (37%) patients, of which 24 (24%) were diagnostically significant, change in acute treatment in 11 (11%) cases and previously unrecognized malignant tumors in 10 (10%) cases. The mean size specific radiation dose was 15.9 mSv (± 3.1 mSv). CONCLUSION: Screening with a multi-rule out CT scan of high-risk patients in an ED is feasible and result in discovery of clinically unrecognized diagnoses and malignant tumors, but at the cost of radiation exposure and downstream examinations. The clinical impact of these findings should be evaluated in a larger randomized cohort.
Authors: James A Goldstein; Kavitha M Chinnaiyan; Aiden Abidov; Stephan Achenbach; Daniel S Berman; Sean W Hayes; Udo Hoffmann; John R Lesser; Issam A Mikati; Brian J O'Neil; Leslee J Shaw; Michael Y H Shen; Uma S Valeti; Gilbert L Raff Journal: J Am Coll Cardiol Date: 2011-09-27 Impact factor: 24.094
Authors: E Sala; C J E Watson; C Beadsmoore; T Groot-Wassink; T R Fanshawe; J C Smith; A Bradley; C R Palmer; A Shaw; A K Dixon Journal: Clin Radiol Date: 2007-07-02 Impact factor: 2.350
Authors: Angela M Mills; Brigitte M Baumann; Esther H Chen; Ke-You Zhang; Lindsey J Glaspey; Judd E Hollander; Jesse M Pines Journal: Postgrad Med Date: 2010-01 Impact factor: 3.840
Authors: Harold I Litt; Constantine Gatsonis; Brad Snyder; Harjit Singh; Chadwick D Miller; Daniel W Entrikin; James M Leaming; Laurence J Gavin; Charissa B Pacella; Judd E Hollander Journal: N Engl J Med Date: 2012-03-26 Impact factor: 91.245
Authors: Udo Hoffmann; Quynh A Truong; David A Schoenfeld; Eric T Chou; Pamela K Woodard; John T Nagurney; J Hector Pope; Thomas H Hauser; Charles S White; Scott G Weiner; Shant Kalanjian; Michael E Mullins; Issam Mikati; W Frank Peacock; Pearl Zakroysky; Douglas Hayden; Alexander Goehler; Hang Lee; G Scott Gazelle; Stephen D Wiviott; Jerome L Fleg; James E Udelson Journal: N Engl J Med Date: 2012-07-26 Impact factor: 91.245
Authors: Joanne C Sierink; Kaij Treskes; Michael J R Edwards; Benn J A Beuker; Dennis den Hartog; Joachim Hohmann; Marcel G W Dijkgraaf; Jan S K Luitse; Ludo F M Beenen; Markus W Hollmann; J Carel Goslings Journal: Lancet Date: 2016-06-28 Impact factor: 79.321