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Title: Novel approaches to the assessment of patients with chest symptoms in the acute medical and outpatient settings : the use of multislice computed tomography
Author: Patterson, Caroline Marie
ISNI:       0000 0004 5371 9473
Awarding Body: Imperial College London
Current Institution: Imperial College London
Date of Award: 2016
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This thesis evaluated the clinical utility of cardiopulmonary computed tomography (CT) in patients presenting with chest pain and dyspnoea. Studies within this thesis confirmed the following. Firstly, there is a requirement for improved diagnostic pathways to minimise patients being discharged without a diagnosis, which currently occurs in 30-40% of patients admitted with chest pain and dyspnoea. Historically, CT has been utilised in 32% of admissions with chest pain and 10% of admissions with dyspnoea. Secondly, challenges exist to the wider adoption of cardiopulmonary CT. These include patient-related factors, institutional capabilities and guideline restrictions. In acute admissions, 11% of patients with dyspnoea and 7% of patients with chest pain and a low to moderate likelihood of CAD are suitable for CT. In the RACPC setting, including patients across the entire spectrum of CAD likelihood, 18% of patients are suitable for CT. NICE CG95 would recommend only 1% of acute chest pain admissions and 2% of RACPC attenders for CT. Thirdly, NICE CG95 would recommend 51% of acute chest pain admissions and 66% of RACPC attenders for discharge without cardiac investigation. In the RACPC population, significant CAD is identified in 10% of these patients and a major adverse cardiac event in 2%. Fourthly, in selected patients with suspected cardiac chest pain, cardiac CT has a diagnostic yield of 21% in acute admissions and 13% in RACPC attenders for significant CAD. In acute admissions with dyspnoea, cardiopulmonary CT has a diagnostic yield of 20% for CAD, 20% for pulmonary embolism, nil for aortic dissection and 89% for non-vascular chest pathology. Fifthly, inclusion of CT in diagnostic pathways for chest pain result in fewer patients discharged without a diagnosis, fewer invasive angiography procedures and reduced diagnostic costs. In patients with dyspnoea, CT provides value to clinicians making diagnoses and supports early discharge without detrimental outcomes.
Supervisor: Bell, Derek ; Padley, Simon Sponsor: Defence Postgraduate Medical Deanery ; Chelsea and Westminster Healthcare
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral