Point-of-care hs-cTn testing reduced emergency department length of stay by 14.4 minutes compared to central laboratory testing among patients with accelerated diagnostic protocol concordant disposition (95% CI −25.9 to −2.9).
RCT (n=1,494)
Open-label
Randomised to POC hs-cTnI testing vs central laboratory hs-cTnT testing
No
Does point-of-care hs-cTn testing reduce emergency department length of stay compared to central laboratory testing in patients with suspected acute coronary syndrome, and what factors modify this effect?
The efficiency gains of point-of-care hs-cTn testing in reducing emergency department length of stay are highly dependent on clinician adherence to accelerated diagnostic protocol recommendations.
Effect estimate: Mean difference −14.4 minutes among patients with ADP concordant disposition (95% CI 95% CI −25.9 to −2.9 minutes)
p-value: p=0.011 for interaction by concordance
Introduction While point-of-care (POC) high-sensitivity cardiac troponin (hs-cTn) testing has the potential to reduce emergency department (ED) length of stay (LOS), evidence of real world effectiveness is lacking. Our objective was to examine factors that influence the real world effectiveness of POC hs-cTn-based accelerated diagnostic protocols (ADPs) in reducing ED LOS. Methods This is a post hoc analysis from the “Aiming towards evidence-based interpretation of cardiac biomarkers in patients presenting with chest pain using POC testing” (WESTCOR-POC) study which included 1494 consecutive patients with suspected acute coronary syndrome presenting to the ED at a moderately sized hospital in Norway. Patients were randomised to receive hs-cTn measurements at admission and after 1 hour either by POC or central laboratory testing. This post hoc analysis examines factors affecting the effectiveness of a POC-based ADP and predictors of non-ADP-concordant disposition. Both outcomes were assessed using regression models, with significance level set at p60 years (OR 2.3, 95% CI 1.4 to 3.7, p=0.001), high triage category (OR 1.9, 95% CI 1.2 to 3.0, p=0.003) and suspected serious differential diagnosis (OR 5.9, 95% 3.5 to 9.9, p<0.001). Conclusion Our findings highlight the need for implementation strategies that support ADP concordant disposition decisions and ensure appropriate patient selection to realise the efficiency potential of POC hs-cTn testing in the ED.
Thulin et al. (Wed,) conducted a rct in Adults aged ≥18 presenting with symptoms suggestive of acute coronary syndrome to emergency department (n=1,494). Point-of-care high-sensitivity cardiac troponin I testing (Atellica VTLi analyzer) vs. Central laboratory high-sensitivity cardiac troponin T testing (Roche Diagnostics) was evaluated on Emergency department length of stay (ED LOS) in minutes from arrival to discharge/admission (Mean difference −14.4 minutes among patients with ADP concordant disposition, 95% CI 95% CI −25.9 to −2.9 minutes, p=0.011 for interaction by concordance). Point-of-care hs-cTn testing reduced emergency department length of stay by 14.4 minutes compared to central laboratory testing among patients with accelerated diagnostic protocol concordant disposition (95% CI −25.9 to −2.9).