Document Detail


Point of care troponin decreases time in the emergency department for patients with possible acute coronary syndrome: a randomised controlled trial.
MedLine Citation:
PMID:  20304883     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
OBJECTIVE: To determine the effect of cardiac troponin I testing with a point-of-care (POC) device versus central laboratory on length of stay (LOS) in emergency department (ED) patients presenting with possible acute coronary syndromes (ACS).
METHODS: A 12-week randomised controlled trial at two metropolitan ED in eastern Australia with a combined annual census of 80,000. Participants were all patients presenting with possible ACS. Exclusions were a diagnosis of ACS before arrival, ST elevation and failure to wait for complete assessment. Randomisation was by week when POC was made available. Primary outcome was LOS from patient arrival to physical departure from the ED. The proportion of patients meeting a government target of less than 8 h stay was compared. Analysis was by intention to treat.
RESULTS: Despite underutilisation of POC, LOS was shorter during weeks when it was available. The time savings translates into approximately 48 minutes (95% CI 12 to 84) per average LOS of almost 7 h, which did not reach statistical significance (p=0.063), or an absolute increase of 10% (95% CI 4.3 to 16.6) in the number of people discharged from the ED within the target LOS of less than 8 h, which did reach significance (p=0.007). These savings were more pronounced in the setting without 24 h central laboratory availability.
CONCLUSIONS: POC testing for troponin in the ED tended to reduce the LOS for possible ACS patients. The degree of this benefit is likely to be markedly dependent on its acceptance and uptake by attending personnel, and on the ED setting in which it is used.
Authors:
Conrad Loten; John Attia; Carolyn Hullick; John Marley; Patrick McElduff
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Emergency medicine journal : EMJ     Volume:  27     ISSN:  1472-0213     ISO Abbreviation:  Emerg Med J     Publication Date:  2010 Mar 
Date Detail:
Created Date:  2010-03-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100963089     Medline TA:  Emerg Med J     Country:  England    
Other Details:
Languages:  eng     Pagination:  194-8     Citation Subset:  IM    
Affiliation:
Hunter New England Health, John Hunter Hospital, Newcastle, Australia. conradloten@gmail.com
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