Emergency department multimarker point-of-care testing reduces time to cardiac marker results without loss of diagnostic accuracy

Alan B. Storrow, Christopher J. Lindsell, Sean P. Collins, Greg J. Fermann, Andra L. Blomkalns, Janet M. Williams, Barbara Goldsmith, W. Brian Gibler

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

We assessed the hypothesis that emergency department point-of-care (POC) testing for myoglobin and cardiac troponin T (cTnT) reduces the time to result with no reduction in diagnostic accuracy for acute coronary syndrome (ACS) compared with standard-of-care local laboratory (LL) tests for creatine kinase-MB (CK-MB) and cTnT. We prospectively compared POC quantitative myoglobin and cTnT with LL results for CK-MB and cTnT in 223 emergency department patients with suspected ACS but no ST-segment elevation. Testing was done at baseline, 3, 6, 12, and 24 hours. Those considered ACS positive had one or more of the following: discharge diagnosis of acute myocardial infarction or unstable angina, positive catheterization, received percutaneous coronary intervention or coronary artery bypass graft, death, or recurrent myocardial infarction during 30-day follow-up. The time from presentation to baseline marker result was compared using paired-sample t test. Diagnostic accuracy was assessed using sensitivity and specificity with associated 95% confidence intervals. Fifty-six patients (25.1%) were ACS positive. Mean ± SD time to baseline results for POC was 2.1 ± 1.4 hours, whereas LL was significantly longer (2.5 ± 1.8 hours, P < 0.01). For baseline, the sensitivity and specificity of POC for ACS were 30% and 91%, respectively, whereas LL was 30% and 92%. When serial blood draws were considered, the sensitivity and specificity were 43% and 88% for POC, and 43% and 91% for LL. Point-of-care testing decreases the time to obtain baseline cardiac markers compared with LL testing; it may be possible to start treatment earlier with POC.

Original languageEnglish (US)
Pages (from-to)132-136
Number of pages5
JournalPoint of Care
Volume5
Issue number3
DOIs
StatePublished - Sep 1 2006

Fingerprint

Point-of-Care Systems
Acute Coronary Syndrome
Hospital Emergency Service
Troponin T
MB Form Creatine Kinase
Myoglobin
Sensitivity and Specificity
Myocardial Infarction
Unstable Angina
Percutaneous Coronary Intervention
Standard of Care
Coronary Artery Bypass
Catheterization
Point-of-Care Testing
Confidence Intervals
Transplants

Keywords

  • Bedside testing
  • Cardiac markers
  • Point-of-care testing

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Storrow, A. B., Lindsell, C. J., Collins, S. P., Fermann, G. J., Blomkalns, A. L., Williams, J. M., ... Gibler, W. B. (2006). Emergency department multimarker point-of-care testing reduces time to cardiac marker results without loss of diagnostic accuracy. Point of Care, 5(3), 132-136. https://doi.org/10.1097/01.poc.0000232334.13428.7a

Emergency department multimarker point-of-care testing reduces time to cardiac marker results without loss of diagnostic accuracy. / Storrow, Alan B.; Lindsell, Christopher J.; Collins, Sean P.; Fermann, Greg J.; Blomkalns, Andra L.; Williams, Janet M.; Goldsmith, Barbara; Gibler, W. Brian.

In: Point of Care, Vol. 5, No. 3, 01.09.2006, p. 132-136.

Research output: Contribution to journalArticle

Storrow, AB, Lindsell, CJ, Collins, SP, Fermann, GJ, Blomkalns, AL, Williams, JM, Goldsmith, B & Gibler, WB 2006, 'Emergency department multimarker point-of-care testing reduces time to cardiac marker results without loss of diagnostic accuracy', Point of Care, vol. 5, no. 3, pp. 132-136. https://doi.org/10.1097/01.poc.0000232334.13428.7a
Storrow, Alan B. ; Lindsell, Christopher J. ; Collins, Sean P. ; Fermann, Greg J. ; Blomkalns, Andra L. ; Williams, Janet M. ; Goldsmith, Barbara ; Gibler, W. Brian. / Emergency department multimarker point-of-care testing reduces time to cardiac marker results without loss of diagnostic accuracy. In: Point of Care. 2006 ; Vol. 5, No. 3. pp. 132-136.
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AB - We assessed the hypothesis that emergency department point-of-care (POC) testing for myoglobin and cardiac troponin T (cTnT) reduces the time to result with no reduction in diagnostic accuracy for acute coronary syndrome (ACS) compared with standard-of-care local laboratory (LL) tests for creatine kinase-MB (CK-MB) and cTnT. We prospectively compared POC quantitative myoglobin and cTnT with LL results for CK-MB and cTnT in 223 emergency department patients with suspected ACS but no ST-segment elevation. Testing was done at baseline, 3, 6, 12, and 24 hours. Those considered ACS positive had one or more of the following: discharge diagnosis of acute myocardial infarction or unstable angina, positive catheterization, received percutaneous coronary intervention or coronary artery bypass graft, death, or recurrent myocardial infarction during 30-day follow-up. The time from presentation to baseline marker result was compared using paired-sample t test. Diagnostic accuracy was assessed using sensitivity and specificity with associated 95% confidence intervals. Fifty-six patients (25.1%) were ACS positive. Mean ± SD time to baseline results for POC was 2.1 ± 1.4 hours, whereas LL was significantly longer (2.5 ± 1.8 hours, P < 0.01). For baseline, the sensitivity and specificity of POC for ACS were 30% and 91%, respectively, whereas LL was 30% and 92%. When serial blood draws were considered, the sensitivity and specificity were 43% and 88% for POC, and 43% and 91% for LL. Point-of-care testing decreases the time to obtain baseline cardiac markers compared with LL testing; it may be possible to start treatment earlier with POC.

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