Introduction of a high sensitivity troponin reduces ED length of stay.

Autor: Singer, Adam J., Heslin, Samita, Skopicki, Hal, On, Chen, Senzel, Lisa B., Tharakan, Mathew, Thode, Henry C., Peacock, Frank
Zdroj: American Journal of Emergency Medicine; Feb2024, Vol. 76, p82-86, 5p
Abstrakt: High sensitivity cardiac troponins (hs-cTn) allow earlier identification and exclusion of acute myocardial infarction. We determined if transitioning from contemporary to high sensitivity troponin T (hs-cTnT) would reduce ED length of stay in chest pain (CP) patients. We conducted a pragmatic, prospective, before and after study of implementing a hs-cTnT by reviewing the electronic health records in all adult ED patients presenting to a large, suburban academic medical center during the 3 months before and after transitioning from a 4th generation troponin to a 5th generation hs-cTnT (Elecsys® Troponin T -high sensitive, Roche Diagnostics, Indianapolis, IN). There were 1431 and 1437 CP patients before and after the intervention. Mean (SD) age was 51.5 (18) yrs. and 54.3% were female. The median (IQR) ED LOS for chest pain patients directly discharged to home was 6.2 (4.7–8.4) and 5.3 (4.0–7.2) hours before and after introducing hs-cTn respectively; difference 47 min (95%CI, 35–59); P < 0.001. The median (IQR) ED LOS for chest pain patients admitted to the hospital was 9.5 (6.6–13.8) and 8.1 (5.7–11.2) hours before and after introducing hs-cTn respectively; difference 77 min (95%CI, 35–121); P < 0.001. Overall admission rates (22 vs 21% both before and after) did not change during the study. The rates of computed tomography coronary angiography before and after the intervention were 21 and 20.4% respectively. The rates of invasive coronary angiography before and after the intervention were 5.8 and 5.6% respectively. Transitioning to a hs-cTnT is associated with a clinically relevant and statistically significant reduction in ED LOS for both discharged and admitted patients with and without CP with no increase in admission or coronary angiography rates. [ABSTRACT FROM AUTHOR]
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