Key result
An accelerated diagnostic protocol using point-of-care troponin I or hsTnT identified more patients for early discharge than the original protocol (15.0% vs 12.3%) with 99.2% sensitivity for ACS.
Why the study?
Does a modified accelerated diagnostic protocol using only troponin at 0 and 2 hours safely identify low-risk patients with chest pain in the emergency department compared to a multimarker panel?
Population
1,000 patients presenting to the emergency department with chest pain suggestive of acute coronary syndrome
Comparison
Modified accelerated diagnostic protocol using… vs Original ADP
Design
Cohort
Follow-up
30 days
Authors
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May support more early discharges in ED chest pain; extends troponin-only protocols observationally but leaves open randomized validation.
Cohort (n=1,000)
Does a modified accelerated diagnostic protocol using only troponin at 0 and 2 hours safely identify low-risk patients with chest pain in the emergency department compared to a multimarker panel?
Absolute Event Rate: 99.2% vs 99.2%
An accelerated diagnostic protocol using a TIMI risk score of 0, no ischemic ECG changes, and negative troponin at 0 and 2 hours safely identifies low-risk chest pain patients for early discharge, performing as well as a multimarker panel.
Aldous et al. (2012) conducted a cohort in Chest pain suggestive of acute coronary syndrome (n=1,000). Accelerated diagnostic protocol (ADP) with point-of-care TnI or hsTnT vs. Original ADP (TIMI=0, no ischemic ECG changes, multimarker panel negative) was evaluated on Acute coronary syndrome (ACS) within 30 days (95% CI 97.5-99.8). An accelerated diagnostic protocol using point-of-care troponin I or hsTnT identified more patients for early discharge than the original protocol (15.0% vs 12.3%) with 99.2% sensitivity for ACS.
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