Why the study?
Does the routine implementation of high-sensitivity troponin (hs-TnT) assays improve clinical outcomes in patients presenting to the emergency department?
Does the routine implementation of high-sensitivity troponin (hs-TnT) assays improve clinical outcomes in patients presenting to the emergency department?
The study outlines a state-wide evaluation of transitioning to high-sensitivity troponin assays, though results are not included in the provided abstract.
Shorter LOS after hs-TnT rollout may ease ED burden; leaves open effects on MI diagnosis rates and outcomes in routine care.
Background: High-sensitivity troponin (hs-TnT) assays improve the diagnostic accuracy of acute myocardial infarction (MI). Whether routinely implementing hs-TnT improves care and outcome remains contentious since reduced specificity for MI may lead to increased investigations and hospitalizations. Purpose: To evaluate the implementation of a single hs-TnT assay across a state-wide health service. Methods: We included all patients presenting to the emergency departments (EDs) of six tertiary hospitals between July 2007 and June 2015. In June 2011 hs-TnT was implemented superseding the 4th generation (4G) TnT assay. Assay change occurred without changing the reference ranges reported to clinicians, despite the 4G TnT level of 30ng/L being equivalent to ∼50ng/L with hs-TnT. Values >30 ng/L were reported as elevated. Clinical outcome data was captured using state-wide linked health records. The impact of assay change was assessed using generalized linear models and interrupted time series (figure 1) allowing for correlation within hospitals, and adjusted for age, gender, presentation month, renal function, Charlson comorbidity index, prior cardiovascular conditions and diabetes.
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Khan et al. (2018) studied this question.