Emergency Department Management of Chest Pain With a High-Sensitivity Troponin-Enabled 0/1-Hour Rule-Out Algorithm

Emergency Department Management of Chest Pain With a High-Sensitivity Troponin-Enabled 0/1-Hour Rule-Out Algorithm

Abstract Objectives The analytical sensitivity of high-sensitivity cardiac troponin T (hsTnT) assays has enabled rapid myocardial infarction rule-out algorithms for emergency department (ED) presentations. Few studies have analyzed the real-world impact of hsTnT algorithms on outcomes and operations...

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Veröffentlicht in:American journal of clinical pathology 2022-05, Vol.157 (5), p.774-780
Hauptverfasser: Bevins, Nicholas J, Chae, Hyojin, Hubbard, Jacqueline A, Castillo, Edward M, Tolia, Vaishal M, Daniels, Lori B, Fitzgerald, Robert L
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container_end_page 780
container_issue 5
container_start_page 774
container_title American journal of clinical pathology
container_volume 157
creator Bevins, Nicholas J
Chae, Hyojin
Hubbard, Jacqueline A
Castillo, Edward M
Tolia, Vaishal M
Daniels, Lori B
Fitzgerald, Robert L
description Abstract Objectives The analytical sensitivity of high-sensitivity cardiac troponin T (hsTnT) assays has enabled rapid myocardial infarction rule-out algorithms for emergency department (ED) presentations. Few studies have analyzed the real-world impact of hsTnT algorithms on outcomes and operations. Methods Comparison of ED length of stay (LOS) and 30-day outcomes (return to ED, inpatient admission, and mortality) for patients presenting with chest pain during 2 separate 208-day periods using a 0/1-hour hsTnT-enabled algorithm or fourth-generation TnT. Results Discharge, 30-day readmission, and 30-day mortality rates were not significantly different with fourth-generation TnT vs hsTnT. Thirty-day return rates were significantly decreased with hsTnT (17.4% vs 14.9%; P 
doi_str_mv 10.1093/ajcp/aqab192
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Few studies have analyzed the real-world impact of hsTnT algorithms on outcomes and operations. Methods Comparison of ED length of stay (LOS) and 30-day outcomes (return to ED, inpatient admission, and mortality) for patients presenting with chest pain during 2 separate 208-day periods using a 0/1-hour hsTnT-enabled algorithm or fourth-generation TnT. Results Discharge, 30-day readmission, and 30-day mortality rates were not significantly different with fourth-generation TnT vs hsTnT. Thirty-day return rates were significantly decreased with hsTnT (17.4% vs 14.9%; P &lt; .01). For encounters with TnT measured at least twice and resulting in discharge, median ED LOS decreased by 61 minutes with the use of hsTnT (488 vs 427 minutes; P &lt; .0001). Median time between first and second TnT results decreased by 82 minutes with hsTnT (202 vs 120 minutes; P &lt; .0001), suggesting that the 0/1-hour algorithm was incompletely adopted. Conclusions Implementation of the hsTnT algorithm was associated with decreased 30-day return rates and decreased ED LOS for a subset of patients, despite incomplete adoption of the 0/1-hour algorithm.</description><identifier>ISSN: 0002-9173</identifier><identifier>EISSN: 1943-7722</identifier><identifier>DOI: 10.1093/ajcp/aqab192</identifier><identifier>PMID: 34893795</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><ispartof>American journal of clinical pathology, 2022-05, Vol.157 (5), p.774-780</ispartof><rights>American Society for Clinical Pathology, 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2021</rights><rights>American Society for Clinical Pathology, 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c2062-1b9820eb11558d89cff0fb32b4f75381c6b84bd6f2772a685b44ad1c3ee584d63</citedby><cites>FETCH-LOGICAL-c2062-1b9820eb11558d89cff0fb32b4f75381c6b84bd6f2772a685b44ad1c3ee584d63</cites><orcidid>0000-0002-8073-5941 ; 0000-0002-4841-9922 ; 0000-0003-4092-7153</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34893795$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bevins, Nicholas J</creatorcontrib><creatorcontrib>Chae, Hyojin</creatorcontrib><creatorcontrib>Hubbard, Jacqueline A</creatorcontrib><creatorcontrib>Castillo, Edward M</creatorcontrib><creatorcontrib>Tolia, Vaishal M</creatorcontrib><creatorcontrib>Daniels, Lori B</creatorcontrib><creatorcontrib>Fitzgerald, Robert L</creatorcontrib><title>Emergency Department Management of Chest Pain With a High-Sensitivity Troponin-Enabled 0/1-Hour Rule-Out Algorithm</title><title>American journal of clinical pathology</title><addtitle>Am J Clin Pathol</addtitle><description>Abstract Objectives The analytical sensitivity of high-sensitivity cardiac troponin T (hsTnT) assays has enabled rapid myocardial infarction rule-out algorithms for emergency department (ED) presentations. Few studies have analyzed the real-world impact of hsTnT algorithms on outcomes and operations. Methods Comparison of ED length of stay (LOS) and 30-day outcomes (return to ED, inpatient admission, and mortality) for patients presenting with chest pain during 2 separate 208-day periods using a 0/1-hour hsTnT-enabled algorithm or fourth-generation TnT. Results Discharge, 30-day readmission, and 30-day mortality rates were not significantly different with fourth-generation TnT vs hsTnT. Thirty-day return rates were significantly decreased with hsTnT (17.4% vs 14.9%; P &lt; .01). For encounters with TnT measured at least twice and resulting in discharge, median ED LOS decreased by 61 minutes with the use of hsTnT (488 vs 427 minutes; P &lt; .0001). Median time between first and second TnT results decreased by 82 minutes with hsTnT (202 vs 120 minutes; P &lt; .0001), suggesting that the 0/1-hour algorithm was incompletely adopted. 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Few studies have analyzed the real-world impact of hsTnT algorithms on outcomes and operations. Methods Comparison of ED length of stay (LOS) and 30-day outcomes (return to ED, inpatient admission, and mortality) for patients presenting with chest pain during 2 separate 208-day periods using a 0/1-hour hsTnT-enabled algorithm or fourth-generation TnT. Results Discharge, 30-day readmission, and 30-day mortality rates were not significantly different with fourth-generation TnT vs hsTnT. Thirty-day return rates were significantly decreased with hsTnT (17.4% vs 14.9%; P &lt; .01). For encounters with TnT measured at least twice and resulting in discharge, median ED LOS decreased by 61 minutes with the use of hsTnT (488 vs 427 minutes; P &lt; .0001). Median time between first and second TnT results decreased by 82 minutes with hsTnT (202 vs 120 minutes; P &lt; .0001), suggesting that the 0/1-hour algorithm was incompletely adopted. 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title Emergency Department Management of Chest Pain With a High-Sensitivity Troponin-Enabled 0/1-Hour Rule-Out Algorithm
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