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VOLUME 27 , ISSUE 3 ( March, 2023 ) > List of Articles

Original Article

The Role of Triple Rule-out CT in an Indian Emergency Setting

Navaneeth Pattereth, Shafneed Chaliyadan, Roshan Mathew, Chandan J Das, Nayer Jamshed

Keywords : Coronary artery disease, Computerized tomography angiography, Emergency medicine

Citation Information : Pattereth N, Chaliyadan S, Mathew R, Das CJ, Jamshed N. The Role of Triple Rule-out CT in an Indian Emergency Setting. Indian J Crit Care Med 2023; 27 (3):190-194.

DOI: 10.5005/jp-journals-10071-24423

License: CC BY-NC 4.0

Published Online: 28-02-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Background: Emergency physicians are acutely aware of the consequences of missing fatal diagnoses for acute non-traumatic chest pain and subjecting patients to over-testing. In the large arsenal of tests that are available to us, a triple rule-out computed tomography (TRO-CT) Angiography is often less pursued, due to concerns about their efficacy and safety or because of nescience. We aim to find the yield of the test in an Indian emergency setting and impart some knowledge about it along the way. Materials and methods: Twenty-six patients who presented to the emergency department of our institute with acute chest pain, with non-specific electrocardiogram (ECG) findings and negative serial troponin I, underwent TRO-CT. HEART scores of all patients, calculated at their presentation, were correlated with TRO-CT findings. Results: Triple rule-out computed tomography angiography was positive in 5 patients (20%), of which 4 cases (16%) were diagnosed to have significant coronary artery disease and one had an acute pulmonary embolism. All 4 patients who had significant coronary artery disease (CAD) diagnosed by TRO-CT had a HEART score of intermediate risk. The mean effective radiation dose of the entire TRO study was 19.024 ± 3.319 mSv (range = 13.89–25.95 mSv). Conclusion: Triple rule-out CT angiography is a useful tool in the evaluation of patients presenting with acute chest pain in the emergency and can be an important adjunct in ruling out significant CAD in intermediate-risk patients. Emergency physicians and young residents need to know about this tool in their armamentarium to tackle doubtful cases.

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