Abstract 372: Ischemic Evaluation in the Ed: Low BOSS Score Associated With Higher Readmission Rates

Abstract

Background: The ideal diagnostic test for suspicion of CAD in the emergency department (ED) is unknown. We developed the Buckeye Optimality Stress Score (BOSS) to assess ischemic evaluation (IE) appropriateness and impact on ED readmission. Methods: The BOSS score assigns points for each type of IE based upon published guidelines. We retrospectively calculated the BOSS score on all ED patients with IE orders (8/2017-11/2017). IE orders were assigned a category of optimal vs. suboptimal reflecting whether or not the IE with the highest BOSS score was used ( optimal ) or not ( suboptimal ). Results: In total, 251 patients were referred from the ED for IE (54 ± 12 years old, women 132 (53%)) of which 182 (73%) had a suboptimal BOSS score. The modality most likely to be optimal was CTA, accounting for 29 (44%) of all IE orders. Patients with diabetes, HTN and CAD were more likely to have a suboptimal BOSS. Cardiology was consulted in 75 (30%), and this was associated with higher CTA IE orders (26 (36%) vs. 26 (15%), p<0.001). Re-presentation to the ED was more likely in those with a suboptimal BOSS on initial IE order (11 (6.1%) vs. 0 (0%), p<0.04). Conclusion: The majority of IE orders from the ED received a suboptimal BOSS, perhaps indicating a gap in understanding of current IE guidelines. These patients were more likely to return to the ED for continued symptoms. Further prospective study of the utility of BOSS score in predicting recurrent presentation and subsequent testing is warranted.