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BackgroundCoronary computed tomography angiography (CCTA) has emerged as a helpful tool in the evaluation of patients with chest pain and suspected coronary artery disease (CAD). The study objective was to evaluate the clinical application of CCTA for assessment of patients presenting with chest pain at a large single urban tertiary health care center located in the US.MethodsA retrospective review of observational data from center was conducted. The study sample included outpatients aged 18 years or older who underwent CCTA during January 2018 through February 2020.ResultsThere were 158 patients in the study, with sixty-two percent having stress testing within 6-months prior to CCTA. Fifty-five percent of these patients had abnormal stress test findings but demonstrated no CAD on CCTA. Among the patients with normal stress tests, 24.4% demonstrated CAD on CCTA. Twenty-five patients underwent invasive coronary angiography (ICA) within the 6-months following CCTA. For these patients, the positive predictive value of CCTA was 91.3% (95% CI: 72.0%, 99.0%) and negative predictive value was 100.0% (95% CI: 15.8%, 100.0%) when compared to ICA results. In addition, CCTA demonstrated myocardial bridging in 10.0% and an anomalous coronary vessel in 8.8% of patients.ConclusionsThis study revealed that CCTA is being used as a diagnostic test in patients presenting with chest pain at the study center. Among patients with prior stress testing, these results were at times potentially inconsistent with the findings from the CCTA. In addition, the CCTA was able to identify variants in anatomical structures.

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) associated infections are a cause of morbidity/mortality in the Intensive Care Unit (ICU). Vancomycin is an option for treatment but is not without its own risks.PurposeTo institute a testing change to decrease time between ordering of MRSA tests and availability of results in patients admitted to the adult ICU.ProceduresA MRSA testing change was implemented at two adult (i.e., tertiary and community) ICUs located in a U.S. Midwestern health system. The change was implemented in 2018 and included the switch from culture to polymerase chain reaction (PCR) in ICU admitted patients. Study data were collected from 2016-2020 and a Bayesian quantile regression model was fit to examine median level change in time to results and to calculate a counterfactual estimate.Main FindingsDuring the 58-month period, 71% of 19,975 patients seen at the two ICUs received MRSA testing. In the pre-change period, 91% and 99% of patients at the tertiary and community hospitals received testing via culture, respectively. Culture was used 1% and ∼0% of the time at the hospitals in the post-change period. The counterfactual estimated 36 (95% CrI: 35, 37) and 32 fewer hours (95% CrI: 31, 33) until results were available at the tertiary and community hospital, respectively.ConclusionsStudy revealed MRSA results were available in less time at both facilities after testing change. This information can aid anti-microbial stewardship via possibly delaying initiation and/or quicker de-escalation of therapy when results are known.