PMID- 26989877
OWN - NLM
STAT- MEDLINE
DCOM- 20170221
LR  - 20170817
IS  - 1742-6723 (Electronic)
IS  - 1742-6723 (Linking)
VI  - 28
IP  - 3
DP  - 2016 Jun
TI  - Clinical impact of a high-sensitivity troponin assay introduction on patients 
      presenting to the emergency department.
PG  - 273-8
LID - 10.1111/1742-6723.12566 [doi]
AB  - OBJECTIVE: Biomarkers are a critical component in the investigation of patients 
      with potential ischaemic heart disease. The proposed benefits of a 
      high-sensitivity troponin (hs-Tn) assay include earlier diagnosis of myocardial 
      infarction. However, the decreased specificity may adversely affect clinical 
      practice. The present study aims to investigate the impact that the introduction 
      of a hs-Tn assay had on patients presenting to the ED. METHODS: A pre- and 
      post-interventional analysis was performed on all patients presenting to the 
      Royal Melbourne Hospital ED, and had a troponin, in the 12 months before and 
      after the introduction of the hs-Tn assay. The main outcome measures were ED 
      length of stay, admission rates, proportion of patients undergoing interventional 
      cardiac procedures and proportion diagnosed with myocardial infarction. RESULTS: 
      There were 6557 patients who had a conventional assay and 7335 patients who had a 
      hs-Tn assay. The introduction of a hs-Tn assay was associated with an increased 
      abnormal troponin rate (23.4% vs 28.1%, P < 0.001). The median length of ED stay 
      decreased by 9.1% (P < 0.001). The proportion admitted to hospital increased 
      (60.9% vs 65.9%, P < 0.001); however, there was no difference in the proportion 
      undergoing revascularisation or the proportion diagnosed with myocardial 
      infarction. CONCLUSIONS: Although the introduction of a hs-Tn assay led to an 
      increase in hospital admissions, the unchanged rate of cardiac procedures or 
      final diagnoses of acute myocardial infarction and ischaemic heart disease 
      suggests that the hs-Tn did not improve the detection of these conditions. It 
      remains unclear whether there was a benefit admitting the additional cohort of 
      patients.
CI  - (c) 2016 Australasian College for Emergency Medicine and Australasian Society for 
      Emergency Medicine.
FAU - Peck, Daniel
AU  - Peck D
AD  - Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, 
      Australia.
FAU - Knott, Jonathan
AU  - Knott J
AD  - Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, 
      Australia.
FAU - Lefkovits, Jeffrey
AU  - Lefkovits J
AD  - Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, 
      Australia.
LA  - eng
PT  - Journal Article
DEP - 20160316
PL  - Australia
TA  - Emerg Med Australas
JT  - Emergency medicine Australasia : EMA
JID - 101199824
RN  - 0 (Biomarkers)
RN  - 0 (Troponin)
SB  - IM
MH  - Aged
MH  - Biomarkers/*blood
MH  - *Emergency Service, Hospital
MH  - Female
MH  - Humans
MH  - Length of Stay/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/blood/*diagnosis
MH  - Patient Admission/statistics & numerical data
MH  - Retrospective Studies
MH  - Sensitivity and Specificity
MH  - Troponin/*blood
OTO - NOTNLM
OT  - emergency department
OT  - myocardial infarction
OT  - myocardial ischaemia
OT  - troponin
EDAT- 2016/03/19 06:00
MHDA- 2017/02/22 06:00
CRDT- 2016/03/19 06:00
PHST- 2015/11/02 00:00 [received]
PHST- 2016/01/04 00:00 [revised]
PHST- 2016/01/31 00:00 [accepted]
PHST- 2016/03/19 06:00 [entrez]
PHST- 2016/03/19 06:00 [pubmed]
PHST- 2017/02/22 06:00 [medline]
AID - 10.1111/1742-6723.12566 [doi]
PST - ppublish
SO  - Emerg Med Australas. 2016 Jun;28(3):273-8. doi: 10.1111/1742-6723.12566. Epub 
      2016 Mar 16.