Does a high-sensitivity troponin I assay and associated accelerated diagnostic protocol reduce Emergency Department length of stay in adults presenting with chest pain of cardiac origin?
Implementation of a high-sensitivity troponin I assay and accelerated diagnostic protocol modestly reduced ED length of stay without increasing 30-day adverse cardiac events.
BackgroundThe objective of this study was to assess the introduction of a high-sensitivity troponin I (hs-TnI) assay and its associated accelerated protocol on ED length of stay (LOS) for patients presenting with chest pain, compared to an accelerated diagnostic protocol (ADP) using conventional troponin (TnI) testing.MethodsWe conducted a retrospective cohort study of all adults with a primary presenting complaint of chest pain of cardiac origin and a Canadian Triage and Acuity Scale (CTAS) score of 2 or 3 between November 8, 2019, and November 9, 2021, to a tertiary care urban Canadian ED. The primary outcome was ED LOS. Secondary outcomes included consultation proportions and Major Adverse Cardiac Events (MACE) within 30 days of the index ED visit.Results2640 patients presenting with chest pain were included, with 1333 in the TnI group and 1307 in the hs-TnI group. Median ED LOS decreased significantly from 392 minutes for the TnI group and 371 minutes for the hs-TnI group (Median difference = 21 minutes; 95% CI: 5.3, 36.7). Consultations and admissions were not statistically different between study periods. The MACE outcomes did not change following the implementation of the hs-TnI test (13.6% vs 13.1%; p = 0.71).ConclusionsThe implementation of an accelerated CP protocol using a hs-TnI assay in a tertiary care Canadian ED was associated with a modest reduction of LOS for all patients and a substantial reduction of LOS for patients undergoing serial troponin testing. Moreover, this strategy was safe with no increase in adverse outcomes.
Hill et al. (Fri,) studied this question.