Introduction of a high sensitivity troponin reduces ED length of stay
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, prosp...
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| Veröffentlicht in: | The American journal of emergency medicine 2024-02, Vol.76, p.82-86 |
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| container_title | The American journal of emergency medicine |
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| creator | Singer, Adam J Heslin, Samita Skopicki, Hal On, Chen Senzel, Lisa B Tharakan, Mathew Thode, Jr, Henry C Peacock, Frank |
| description | 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 |
| doi_str_mv | 10.1016/j.ajem.2023.11.028 |
| format | Article |
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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.</description><identifier>ISSN: 0735-6757</identifier><identifier>ISSN: 1532-8171</identifier><identifier>EISSN: 1532-8171</identifier><identifier>DOI: 10.1016/j.ajem.2023.11.028</identifier><identifier>PMID: 38006636</identifier><language>eng</language><publisher>United States: Elsevier Limited</publisher><subject>Adult ; Algorithms ; Angiography ; Biomarkers ; Cardiology ; Chest ; Chest Pain - diagnosis ; Computed tomography ; Electronic medical records ; Emergency medical care ; Emergency Service, Hospital ; Female ; Females ; Heart attacks ; Hospitals ; Humans ; Length of Stay ; Male ; Medical imaging ; Middle Aged ; Myocardial infarction ; Pain ; Patients ; Prospective Studies ; Rates of return ; Statistical analysis ; Tomography ; Troponin ; Troponin T</subject><ispartof>The American journal of emergency medicine, 2024-02, Vol.76, p.82-86</ispartof><rights>Copyright © 2023 Elsevier Inc. All rights reserved.</rights><rights>2023. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c282t-7d2940664e03c7141410cf53aaa4abd7b8c5058cdab9cfca18d01b32759153603</cites></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/38006636$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Singer, Adam J</creatorcontrib><creatorcontrib>Heslin, Samita</creatorcontrib><creatorcontrib>Skopicki, Hal</creatorcontrib><creatorcontrib>On, Chen</creatorcontrib><creatorcontrib>Senzel, Lisa B</creatorcontrib><creatorcontrib>Tharakan, Mathew</creatorcontrib><creatorcontrib>Thode, Jr, Henry C</creatorcontrib><creatorcontrib>Peacock, Frank</creatorcontrib><title>Introduction of a high sensitivity troponin reduces ED length of stay</title><title>The American journal of emergency medicine</title><addtitle>Am J Emerg Med</addtitle><description>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.</description><subject>Adult</subject><subject>Algorithms</subject><subject>Angiography</subject><subject>Biomarkers</subject><subject>Cardiology</subject><subject>Chest</subject><subject>Chest Pain - diagnosis</subject><subject>Computed tomography</subject><subject>Electronic medical records</subject><subject>Emergency medical care</subject><subject>Emergency Service, Hospital</subject><subject>Female</subject><subject>Females</subject><subject>Heart attacks</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Length of Stay</subject><subject>Male</subject><subject>Medical imaging</subject><subject>Middle Aged</subject><subject>Myocardial infarction</subject><subject>Pain</subject><subject>Patients</subject><subject>Prospective Studies</subject><subject>Rates of return</subject><subject>Statistical analysis</subject><subject>Tomography</subject><subject>Troponin</subject><subject>Troponin T</subject><issn>0735-6757</issn><issn>1532-8171</issn><issn>1532-8171</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNpdkLFOwzAURS0EoqXwAwwoEgtLgp8dJ86ISoFKlVhgthzHaR0lTrETpP49jloYkIe3nHuf30HoFnACGLLHJpGN7hKCCU0AEkz4GZoDoyTmkMM5muOcsjjLWT5DV943GAOkLL1EM8oxzjKazdFqbQfXV6MaTG-jvo5ktDPbXeS19WYw32Y4RAHY99bYyOkAah-tnqNW2-2wmwJ-kIdrdFHL1uub01ygz5fVx_It3ry_rpdPm1gRToY4r0iRhsWpxlTlkIaHVc2olDKVZZWXXDHMuKpkWahaSeAVhpKSnBXhrAzTBXo49u5d_zVqP4jOeKXbVlrdj14QXlA-1dKA3v9Dm350NvxOkAKyFFhRTBQ5Usr13jtdi70znXQHAVhMkkUjJslikiwARJAcQnen6rHsdPUX-bVKfwBgVXeD</recordid><startdate>202402</startdate><enddate>202402</enddate><creator>Singer, Adam J</creator><creator>Heslin, Samita</creator><creator>Skopicki, Hal</creator><creator>On, Chen</creator><creator>Senzel, Lisa B</creator><creator>Tharakan, Mathew</creator><creator>Thode, Jr, Henry C</creator><creator>Peacock, Frank</creator><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202402</creationdate><title>Introduction of a high sensitivity troponin reduces ED length of stay</title><author>Singer, Adam J ; 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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><cop>United States</cop><pub>Elsevier Limited</pub><pmid>38006636</pmid><doi>10.1016/j.ajem.2023.11.028</doi><tpages>5</tpages></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete |
| subjects | Adult Algorithms Angiography Biomarkers Cardiology Chest Chest Pain - diagnosis Computed tomography Electronic medical records Emergency medical care Emergency Service, Hospital Female Females Heart attacks Hospitals Humans Length of Stay Male Medical imaging Middle Aged Myocardial infarction Pain Patients Prospective Studies Rates of return Statistical analysis Tomography Troponin Troponin T |
| title | Introduction of a high sensitivity troponin reduces ED length of stay |
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