Key result
Point-of-care hs-cTnI cuts emergency department length of stay by ~47 minutes vs. central laboratory testing.
Why the study?
Point-of-care high-sensitivity cardiac troponin testing may expedite decision-making and reduce ED length of stay for patients with possible myocardial infarction, but its real-life effectiveness and safety needed assessment.
Does point-of-care high-sensitivity cardiac troponin testing reduce emergency department length of stay in patients presenting with possible acute coronary syndrome?
RCT (n=44,747)
Stepped-wedge cluster-randomized
Yes
Does point-of-care high-sensitivity cardiac troponin testing reduce emergency department length of stay in patients presenting with possible acute coronary syndrome?
Mean Difference: -47 (95% CI -61–-33)
p-value: p=<0.001
Implementation of a point-of-care high-sensitivity troponin I assay safely reduced emergency department length of stay by 47 minutes compared to central laboratory testing without increasing 30-day adverse cardiac events.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Early decision-making using a point-of-care high-sensitivity troponin assay within a structured clinical pathway was safe. Faster turnaround means troponin results are consistently available when clinicians first seek them. This can facilitate earlier decisions and reduce patient length of stay.”
Point-of-care hs-cTnI shortens ED stays in suspected ACS; leaves open effects on outcomes and implementation.
BACKGROUND: Point-of-care high-sensitivity cTn (cardiac troponin; hs-cTn) testing has the potential to expedite decision-making and reduce emergency department (ED) length of stay for patients presenting with possible myocardial infarction by ensuring that results are consistently available when sought by clinicians. We assessed the real-life effectiveness and safety of implementing point-of-care hs-cTn testing in the ED. METHODS: We conducted a pragmatic, stepped-wedge cluster-randomized trial. The control arm was usual care with an accelerated diagnostic pathway using a single-sample rule-out step with a central laboratory hs-cTn assay. The intervention arm used the same pathway with a point-of-care hs-cTnI assay. The primary effectiveness outcome was ED length of stay assessed using a generalized linear mixed model. The safety outcome was myocardial infarction or cardiac death within 30 days. RESULTS: Six sites participated, with 59 980 ED presentations (44 747 individuals; mean 61±19 years of age; 49.5% female) from February 2023 through January 2025; 31 392 presentations were during the intervention arm. After adjustment for covariates associated with length of stay, the intervention reduced length of stay by 13% (95% CI, 9%–16%; P <0.001), corresponding to a reduction of 47 minutes (95% CI, 33–61 minutes) from a mean length of stay in the control arm of 376 minutes. The 30-day myocardial infarction or cardiac death rate was similar in the control and intervention arms (0.39% and 0.39%, respectively; P =0.54). CONCLUSIONS: Implementation of whole-blood hs-cTnI testing at the point of care into an accelerated diagnostic pathway was safe and reduced length of stay in the ED compared with laboratory testing. REGISTRATION: URL: https://www.anzctr.org.au ; Unique identifier: ACTRN12619001189112.
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Than et al. (2026) conducted an RCT in Possible Acute Coronary Syndrome (n=44,747). Point-of-care high-sensitivity troponin (hs-cTnI) assay vs. Central laboratory hs-cTn assay was evaluated on Emergency department length of stay (Reduction of 47 minutes, 95% CI 33-61, p=<0.001). Point-of-care high-sensitivity cTnI testing reduced emergency department length of stay by 47 minutes (95% CI, 33-61; P<0.001) compared with central laboratory testing.
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