Is it safe to discharge patients from accident and emergency using a rapid point of care Triple Cardiac Marker test to rule out acute coronary syndrome in low to intermediate risk patients presenting with chest pain?

Effect on emergency department efficiency of an accelerated diagnostic pathway for the evaluation of chest pain

“…This is most marked for chest pain patients being discharged, with the median ED LOS being reduced from about 9 h to 5 h. The less marked reduction in ED LOS for admitted chest pain patients is not surprising, given the complexities involved in patient admission and the ongoing issue of access block. These reductions in individual patient efficiency measures are generally consistent with those previously published in the literature 13–19 …”

“…Although diagnostic performance was monitored and reported, this study was not powered to examine the ADP with any precision in this regard. The point estimates obtained, however, were within the range reported in other studies, which have favourably compared the diagnostic sensitivity of TDP and ADP 13–19 . Both of the apparent false negative cases were high clinical risk and were admitted as unstable angina.…”

“…As cTnI is a late marker of myocardial damage, simultaneously testing cTnI with early markers, such as myoglobin and the creatine kinase‐MB fraction (CK‐MB), has led to the development of accelerated diagnostic pathways (ADP), which have been reported to allow acceptably safe rule‐out of acute myocardial necrosis within 2 h for the majority of patients 13–19 . Point‐of‐care (POC) technology also allows these assays to be performed in under 20 min, well within the recommended turnaround time of less than 60 min, which most central hospital labs are unable to meet 20,21…”

“…Studies comparing ADP with traditional diagnostic pathways (TDP) based on central lab cTnI assays have generally reported significant reductions in time to ED disposal decision‐making and ED length of stay (LOS) for the relevant patient group, 13–19 although effects on admission rates 17,21 and general cost‐effectiveness have been variable 22,23 . Potential benefits from an ADP on whole ED efficiency have not been explored.…”

Comparison of new point-of-care troponin assay with high sensitivity troponin in diagnosing myocardial infarction

“…Although there appears to be a shorter time to treatment in those with AMI when POC assays are used, a previous systematic review did not show improvement in outcomes although were also not inferior [25]. It should be noted that many of the studies included in the review used older less sensitive assays.…”