The Comparison of waiting time between point of care testing Troponon-I and Central laboratory Troponin-T in atypical chest pain at Emergency department Saraburi hospital
Keywords:Chest pain, Cardiac enzyme, Waiting times
Patients arrive at emergency department with atypical chest pain. The procedure for the diagnosis of acute coronary disease necessarily involves various factors including history taking, physical examination, and EKG and laboratory investigation on cardiac enzyme, the result of which can be obtained by applying Point of Care Test (POCT) placed in emergency department than through central laboratory. This study aims to compare between Protocol TnI (POCT) and Protocol TnT (Hs) regarding the reduction of waiting time (primary outcome) and discharge status form the ED (secondary outcome). The study is a randomized controlled trial on 80 patients that arrive at the Emergency Department of Saraburi Hospital with atypical chest pain between 1st July to 31st December 2020. The patients are randomized into 2 Protocol with 40 patients each. The duration since the arrival to the hospital, through examination by doctor, the receipt of correct cardiac enzyme and departure from the ED, as well as the discharge status and diagnosis were collected. The comparison between Protocol TnI (POCT) and Protocol TnT (Hs) resulted in that there was no statistically significant difference between the positive results at 0 hour and 3 hours, with p-value = 0.3 and 0.18, respectively. The waiting time since patient came in ED exam by doctor, correct cardiac enzyme and leave from ED was no significantly in at p-value= 0.15, 0.94 and 0.85. The mean interval times in protocol TnI (POCT) were 25.2, 88.8 and 408.0 minutes. The mean interval time in protocol TnT(Hs) were 29.4, 57.6 and 363.6 minutes. In term of discharge status, more patients were safely discharged and returned home. Likewise, there was no statistically significant difference between those patients admitted due to acute coronary disease and those admitted due to non-acute coronary disease, p-value 0.17 and 0.24, respectively, compared with those discharged. The comparison between Protocol TnI (POCT) and Protocol TnT(Hs) in patients with atypical chest pain show no significant difference in waiting time and discharge status form the ED
Herren KR, Mackway-Jones K. Emergency manangement of cardiac chest pain: A review. Emerg Med J. 2001;18(1):6–10.
Hjortshøj S, Venge P, Ravkilde J. Clinical performance of a new point-of-care cardiac troponin I assay compared to three laboratory troponin assays. Clin Chim Acta. 2011;412(3–4):370–5.
Juliano M, Wason C. Comparison of Point-of-Care Versus Laboratory Troponin Testing in an Emergency Department Setting. Mil Med. 2017;182(7):e1938–40.
Chapman AR, Stewart S, Mills NL. Contemporary point of care cardiac troponin testing in suspected acute coronary syndrome. Heart. 2019;105(10):740–1.
Bingisser R, Cairns C, Christ M, Hausfater P, Lindahl B, Mair J, et al. Cardiac troponin: A critical review of the case for point-of-care testing in the ED. Am J Emerg Med. 2012;30(8):1639–49.
Denis AB, Pose A, Quinteros S. Point of care in Clinicas Hospital, Uruguay: 10 years experience. Clin Chim Acta. 2019;493:S643.
Amsterdam EA, Kirk JD, Bluemke DA, Diercks D, Farkouh ME, Garvey JL, et al. Testing of low-risk patients presenting to the emergency department with chest pain: A scientific statement from the American Heart Association. Circulation. 2010;122(17):1756–76.
Than M, Cullen L, Aldous S, Parsonage WA, Reid CM, Greenslade J, et al. 2-Hour accelerated diagnostic protocol to assess patients with chest pain symptoms using contemporary troponins as the only biomarker: The ADAPT trial. J Am Coll Cardiol . 2012;59(23):2091–8.
Than M, Cullen L, Reid CM, Lim SH, Aldous S, Ardagh MW, et al. A 2-h diagnostic protocol to assess patients with chest pain symptoms in the Asia-Pacific region (ASPECT): A prospective observational validation study. Lancet. 2011;377(9771):1077–84.
Cullen L, Greenslade JH, Hawkins T, Hammett C, O’Kane S, Ryan K, et al. Improved assessment of chest pain trial (IMPACT): Assessing patients with possible acute coronary syndromes. Med J Aust. 2017;207(5):195–200.
Nowak RM, Christenson RH, Jacobsen G, McCord J, Apple FS, Singer AJ, et al. Performance of Novel High-Sensitivity Cardiac Troponin I Assays for 0/1-Hour and 0/2- to 3-Hour Evaluations for Acute Myocardial Infarction: Results From the HIGH-US Study. Ann Emerg Med . 2020;1–13.
Ojeda F, Neumann JT, So NA, Blankenberg S, Westermann D. Early diagnosis of acute myocardial infarction using high-sensitivity troponin I. 2017;1–10.
Kendall J, Reeves B, Clancy M. Point-of-care testing: a randomized controlled trial of clinical outcome. BMJ. 1998; 316:1052-7.
DeVon HA, Mirzaei S, Zègre-Hemsey J. Typical and Atypical Symptoms of Acute Coronary Syndrome: Time to Retire the Terms? J Am Heart Assoc. 2020;9(7):e015539.
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