Key result
Point-of-care troponin testing is unlikely to reduce evacuation rates for chest pain, as 89.4% of patients already required evacuation based on an elevated HEAR score alone.
Why the study?
To determine whether there is utility in conducting point-of-care troponin testing for patients presenting with chest pain at remote outpost nursing stations without onsite physicians or troponin capabilities.
Does the addition of point-of-care troponin to the HEAR score reduce the rate of medical evacuation for patients with chest pain at remote nursing stations?
Observational (n=124)
Yes
Does the addition of point-of-care troponin to the HEAR score reduce the rate of medical evacuation for patients with chest pain at remote nursing stations?
Point-of-care troponin testing is unlikely to reduce the rate of medical evacuation for chest pain patients from remote nursing stations, as most already have an elevated HEAR score requiring transfer.
Answers are grounded in this paper and cite their sources.
HEAR scores may already determine most evacuations from remote outposts; leaves open whether point-of-care troponin meaningfully alters disposition.
INTRODUCTION: The HEART scoring system codifies the clinical gestalt used by physicians with 0-2 points assigned to 5 criteria (history, electrocardiography, age, risk factors and troponin). This scoring provides a prognostic tool that assists in disposition planning. The use of a truncated HEART score, minus the troponin data (HEAR score), was used for patients presenting with chest pain at one of four outpost nursing stations served by La Ronge Health Centre in northern Saskatchewan. These nursing stations have no onsite physician and no ability to obtain any troponin data. This study set out to determine if there was any utility in conducting point-of-care (PoC) troponins in these nursing outposts. MATERIALS AND METHODS: A retrospective analysis was conducted using the La Ronge regional electronic medical record by searching for all patients for whom an outpost nurse had called a physician regarding chest pain symptoms between 01 January 2011 and 31 December 2016. The HEAR and HEART score were then calculated for each individual presentation of patients with chest pain that met inclusion and exclusion criteria. RESULTS: By calculating both the patient's HEART score before evacuation from the outposts and after (i.e. with the troponin data), we were able to determine that, in 89.4% of cases (110/123 events), patients would require evacuation regardless of the troponin values due to a HEART score ≥4. In 10.6% (13/124 events) of cases, the patients who were evacuated had a HEART score ≤3, and in only one case did the troponin data increase this score. CONCLUSIONS: The majority of patients would continue to be evacuated regardless of the result of their PoC troponin due to an already elevated HEAR score. PoC troponin is unlikely to reduce the rate of evacuation of patients with chest pain from the nursing stations served by the La Ronge Health Centre.
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Kapur et al. (2021) conducted an observational in Chest pain (n=124). Point-of-care (PoC) troponin testing (HEART score) vs. HEAR score (clinical assessment without troponin) was evaluated on Requirement for evacuation (HEART score ≥4) regardless of troponin values. Point-of-care troponin testing is unlikely to reduce evacuation rates for chest pain, as 89.4% of patients already required evacuation based on an elevated HEAR score alone.
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