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Point of care troponin decreases time in the emergency department for patients with possible acute coronary syndrome: a randomised controlled trial
  1. Conrad Loten1,
  2. John Attia1,2,
  3. Carolyn Hullick1,
  4. John Marley3,
  5. Patrick McElduff4
  1. 1John Hunter Hospital, Newcastle, Australia
  2. 2Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, Australia
  3. 3Faculty of Health Sciences, The University of Queensland, Brisbane, Australia
  4. 4Hunter Medical Research Institute, School of Medicine and Public Health University of Newcastle, Newcastle, Australia
  1. Correspondence to Dr Conrad Loten, Emergency Physician, Hunter New England Health, John Hunter Hospital, Locked Bag 1, Hunter Region Mail Centre, Newcastle 2310, Australia; conradloten{at}gmail.com

Abstract

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.

  • Acute coronary syndrome
  • cardiac care
  • emergency department
  • point of care
  • troponin

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Footnotes

    fn-7
  • Funding This study was funded by the NSW government, Department of Health.

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  • Ethics approval Ethics permission, and exemption from patient consent, was granted by our regional ethics committee.

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  • Provenance and peer review Not commissioned; externally peer reviewed.

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