Trial for the Use of Pretest Probability to Reduce Unnecessary Testing for Low-Risk Patients With Chest Pain

Status unconfirmed · Phase 3

Conditions studied: Acute Coronary Syndrome

In brief

The purpose of this study is to evaluate if the implementation of quantitative pretest probability assessment will significantly reduce the unnecessary use of the intra-emergency department chest pain center. Specifically, the study will examine whether the PREtest Consult acute coronary syndrome (ACS) pretest probability assessment system can significantly reduce the use of chest pain unit evaluation in very low risk emergency department (ED) patients, can safely discharge patients with a pretest probability ≤ 2.0%, can reduce unnecessary procedures and lower hospital costs and will examine patient satisfaction of patients with whom pretest probability assessment was used compared to those with whom it was not used. The researchers hypothesize that patients in the control group of the study will have statistically significant reductions in mean time spent in the emergency department, mean charges billed to the patient or their insurance carrier, hospital length of stay, mean number of procedures or tests performed without a statistically significant change in patient satisfaction or adverse outcome.

Key facts

Study ID

NCT00243516

Run by

PREtest Consult

People needed

400

Starts

2005-10-01

Expected to finish

2007-10-01

Last updated by the study team

2007-11-09

Who can join

Age: 18 and older. Sex: any. Healthy volunteers: not accepted.

You may qualify if…

• Emergency department patients aged > 17 who report a history of torso or arm discomfort within the past 24 hours.
• Physician orders an electrocardiogram and serum troponin measurement.
• Physician has undergone a 10 minute explanation session and has provided consent

You may not qualify if…

• 12-lead electrocardiogram (ECG) with ST deviation or T-wave changes that are interpreted by clinician as indicative of acute infarction or ischemia
• "Code STEMI" patients (patients with suspected acute myocardial infarction).
• Other primary diagnosis mandating admission (e.g., pneumonia, diabetic ketoacidosis, trauma)
• Patients with myocardial infarction, intracoronary stent placement, or coronary artery bypass grafting within the previous 30 days.
• Evidence of circulatory shock (SBP [systolic blood pressure] < 100 mmHg with symptoms defined by Jones)
• Cocaine use within the past 72 hours.
• A moderate to high-risk composite clinical picture that causes an emergency medicine specialist to consult a cardiologist.
• Homelessness, out-of-town residence or other condition known to preclude follow-up.
• Prisoners and pregnant patients

Where it is running

• Carolinas Medical Center — Charlotte, North Carolina, United States (enrolling)

Full record on ClinicalTrials.gov

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