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Study Hints At Excess CT For Morbidly Obese

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Morbid obesity may lead to unnecessary imaging of emergency patients who have chest pain or shortness of breath, according to a new study published online Tuesday in Circulation: Cardiovascular Quality and Outcomes.

The study primarily found differences in weight-related costs associated with treating such patients. Using a baseline of normal-weight patients, as measured by body mass index, the study found medical costs to be the following:

  • 22 percent higher for overweight patients
  • 28 percent higher for obese patients
  • 41 percent higher for morbidly obese patients

The study also looked at imaging. It found that morbidly obese patients who did not undergo a CT pulmonary angiogram stayed in the hospital 34 percent longer than patients of normal weight—but that morbidly obese patients who did have a CT scan stayed 44 percent longer.

The authors made the following comments:

Morbid obesity with CT scanning and morbid obesity without CT scanning were both associated with increased length of stay. Morbidly obese patients also had a higher rate of no significant cardiopulmonary diagnosis for 90 days after CT pulmonary angiography, which some may interpret as a higher rate of unnecessary imaging.

The percentage of patients who underwent a CT scan resulting in no significant cardiopulmonary diagnosis was highest among the morbidly obese: 87 percent. For normal-weight patients, it was 81 percent.

Patients were categorized according to the following BMI results:

  • Underweight: less than 18.5
  • Normal weight: at least 18.5 but less than  25
  • Overweight: at least 25 but less than 30
  • Obese: at least 30 but less than 40
  • Morbidly obese: 40 or more

The authors concluded that one-size-fits-all doesn’t work in the emergency department: “These results emphasize a need for specific protocols to manage morbidly obese patients presenting to the ED with chest pain and dyspnea.”

The authors also suggested that physicians might need better education about how to avoid unnecessary CT imaging.

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Bloomberg News says some heart patients were coached to show up in a New York emergency room and complain of specific symptoms, possibly to get insurance to cover their coronary angioplasties. For details, see our Facebook page.

Related CME seminar (up to 12 AMA PRA Category 1 credits™): UCSF Cardiovascular & Pulmonary Imaging

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