Point of care troponin decreases time in the emergency department for patients with possible acute coronary syndrome: a randomised controlled trial

Abstract

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.

Impact from point-of-care devices on emergency department patient processing times compared with central laboratory testing of blood samples: a randomised controlled trial and cost-effectiveness analysis

“…A before/after study design8 using POC troponin testing for ACS demonstrated shorter ED LOS and time to admission decisions, a quasi-randomised trial9 demonstrate only a trend to shorter ED LOS, while two randomised trials failed to demonstrate a benefit 10 11. In studies of POC testing using machines that perform a variety of blood tests, two before/after studies demonstrated shorter ED LOS12 13 while a third did not,14 a small randomised trial found a shorter ED LOS,15 but a large randomised trial was unable to demonstrate a difference in ED LOS, hospital LOS, admission rates or mortality 16.…”

Effectiveness of practices for improving the diagnostic accuracy of Non ST Elevation Myocardial Infarction in the Emergency Department: A Laboratory Medicine Best Practices™ systematic review

“…For the diagnostic accuracy outcome effect size, one study [61] documented an adverse effect rated “Substantial”, one study [59]) had a favorable effect rated “Substantial”, one study [38] had a favorable effect rated “Moderate”, and three [43][60][62] had effect sizes rated “Minimal/None”. One study [37], rated “Fair” with “Moderate” effect size, found improvement in TAT, but there was not sufficient evidence to evaluate further.…”

“…While POCT cTn has the potential to reduce TAT [59][41], and LOS [60], the body of evidence regarding this practice was insufficient and inconsistent for conclusions. However, there is sufficient published evidence to determine the equivalency of POCT assays to laboratory assays and we recommend additional studies be conducted to measure the effect of POCT cTn implementation.…”

“…) Unpublished studies included:  2 total − 0 = 2 Point of Care Testing 11 published studies Three studies [32][57][58] were excluded for failing to meet quality criteria. Other studies are reported as follows:  1 Study = Good/Moderate [38]  2 Studies = Good/Minimal [43][60]  3 Studies = 2, Fair/Substantial Pos [ 41][59];  1, Fair/Substantial Neg [61]  1 Study = Fair/Moderate [37]  1 Study = Fair/Minimal [62] Graphically represented as follows:    Eight studies reported inconsistent effects and direction. No recommendation was made.  Published studies included:  11 total − 3 = 8 Total Studies Included = 15 1 1 In this particular instance, authors use “studies” to denote “reports” or “articles.” 2 While Figure 2 is inclusive of all studies included for evaluation, several studies were removed for failing to meet a specific evaluation criterion or due to cTn assay issues. Published Studies Included = 4 + 4 + 5 = 13Unpublished Studies Included = 3 − 1 (2 analyses from same reference study) = 2Total Studies Included = 13 + 2 = 15 1 3 Later, authors use “studies” to denote practice “analyses”: For example, “A total of 24 published and 2 unpublished studies (Storrow 2014 [42] was unpublished at time of evaluation) were deemed acceptable for inclusion.” See section “3.0 Evidence review synthesis and results”(1) Six published studies contained data evaluating two practices.  Math: 15 1 + 6 extra analyses = 21 analyses(2) One unpublished study contained data evaluating two practices.  Math: 21 + 1 extra analysis = 22 analyses(3) Two published studies contained data evaluating three practices.  Math: 22 + 4 extra analyses =     26 Total Analyses …”

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

“…Turnaround times from blood sampling to results can therefore be highly important both to meet policy targets and for efficient patient disposition and initiation of definitive treatment [11]. Previous studies have had varying results regarding the effect of POC devices on length of stay with some showing improvement and some not [11,17,[20][21][22][23]. However, some authors ascribe the inconsistent improvement in lengths of stay, occurring in some centres but not others, to how POC results are incorporated into the assessment pathways.…”