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Adam J Singer, Justin Williams, Maria Taylor, Deborah Le Blanc, Henry C Thode
OBJECTIVE: We determined the effects of comprehensive point-of-care testing (POCT) on process of care in critically ill emergency department (ED) patients. We hypothesized that POCT would shorten ED length of stay (LOS), reduce time to test results, and reduce time to completion of intravenous (IV) contrast computed tomography (CT) imaging compared with central lab testing. METHODS: A before and after study was performed in ED patients triaged to the critical care area...
June 2015: American Journal of Emergency Medicine
Ewoud Ter Avest, Anniek Visser, Bram Reitsma, Rob Breedveld, Albert Wolthuis
OBJECTIVE: Point-of-care testing (POCT) cardiac troponin (cTn) measurements are being used increasingly, despite the fact that evidence on the safety of their use is outdated, not taking into account current 'gold standard' high-sensitivity cardiac troponin (hs-cTn) assays. In the present study, we aimed to compare the analytical and diagnostic performance of the AQT90-flex POCT cTnT assay (which is the POCT assay with the lowest reported 99th percentile cutoff currently available) with the laboratory-based Roche Modular E170 hs-cTnT assay...
April 2016: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
Sally Aldous, A Mark Richards, Peter M George, Louise Cullen, William A Parsonage, Dylan Flaws, Christopher M Florkowski, Richard W Troughton, Jack W O'Sullivan, Christopher M Reid, Laura Bannister, Martin Than
OBJECTIVES: The aim of this study is to compare a new improved point of care cardiac troponin assay (new POC-cTnI) with 1. its predecessor (old POC-cTnI) and 2. a high sensitivity assay (hs-cTnI) for the diagnosis of acute myocardial infarction (AMI) and for major adverse cardiac events (MACE) by 30 days. METHODS: This is a single centre observational study, set in Christchurch Hospital, New Zealand. Patients presenting to the emergency department with non-traumatic chest pain underwent blood sampling at 0 h and 2h post presentation for analysis with the 3 cTnI assays for the outcome of AMI and for analysis using an accelerated diagnostic protocol (ADP-normal 2h troponins, normal electrocardiograms and Thrombolysis In Myocardial Infarction (TIMI) score of 0 or ≤ 1) for 30 day MACE...
November 15, 2014: International Journal of Cardiology
Madeleine H E Bruins Slot, Geert J M G van der Heijden, Saskia D Stelpstra, Arno W Hoes, Frans H Rutten
BACKGROUND: A review of cardiac point-of-care (POC) tests used to detect or exclude acute myocardial infarction (AMI) with a focus on test performance within 6 hours after the start of symptoms. METHODS: A systematic review of articles on the diagnostic accuracy of point of care (POC) tests in patients suspected of AMI from the PubMed database from January 1st 1990 to December 1st 2012. RESULTS: Our search yielded 42 studies evaluating POC tests...
October 15, 2013: International Journal of Cardiology
Carsten Stengaard, Jacob Thorsted Sørensen, Søren Andreas Ladefoged, Erika Frischknecht Christensen, Jens Flensted Lassen, Hans Erik Bøtker, Christian Juhl Terkelsen, Kristian Thygesen
Improvement of prehospital triage is essential to ensure rapid management of patients with acute myocardial infarction (AMI). This study evaluates the feasibility of prehospital quantitative point-of-care cardiac troponin T (POC-cTnT) analysis, its ability to identify patients with AMI, and its capacity to predict mortality. The study was performed in the Central Denmark Region from May 2010 to May 2011. As a supplement to electrocardiography, a prehospital POC-cTnT measurement was performed by a paramedic in patients with suspected AMI...
November 1, 2013: American Journal of Cardiology
Devin Loewenstein, Christine Stake, Mark Cichon
PURPOSES: The purpose of this study is to compare fingerstick point-of-care (POC) testing for cardiac troponin I to conventional venipuncture POC testing using the i-STAT device. BASIC PROCEDURES: This study was conducted with institutional review board approval in the emergency department (ED) of a 535-bed suburban level I trauma center from June to August 2011. Fingerstick blood samples were collected from consenting patients for whom standard-of-care venipuncture POC troponin (POCT) testing had been ordered as part of their workup...
August 2013: American Journal of Emergency Medicine
Ji Yeon Jang, Sang Do Shin, Eui Jung Lee, Chang Bae Park, Kyoung Jun Song, Adam J Singer
STUDY OBJECTIVE: Awaiting results from laboratory testing may sometimes be a rate-limiting step in emergency department (ED) throughput prolonging length of stay and contributing to crowding. We determine whether introduction of a comprehensive metabolic panel point-of-care test can reduce ED length of stay compared with traditional central laboratory testing. METHODS: We performed a randomized, controlled trial among 10,244 noncritically ill ED patients aged 15 years and older whose physicians ordered a comprehensive metabolic panel at a single, large, academic, urban medical center...
February 2013: Annals of Emergency Medicine
Roland Bingisser, Charles Cairns, Michael Christ, Pierre Hausfater, Bertil Lindahl, Johannes Mair, Mauro Panteghini, Christopher Price, Per Venge
The measurement of cardiac troponin concentrations in the blood is a key element in the evaluation of patients with suspected acute coronary syndromes, according to current guidelines, and contributes importantly to the ruling in or ruling out of acute myocardial infarction. The introduction of point-of-care testing for cardiac troponin has the potential to reduce turnaround time for assay results, compared with central laboratory testing, optimizing resource use. Although, in general, many point-of-care cardiac troponin tests are less sensitive than cardiac troponin tests developed for central laboratory-automated analyzers, point-of-care systems have been used successfully within accelerated protocols for the reliable ruling out of acute coronary syndromes, without increasing subsequent readmission rates for this condition...
October 2012: American Journal of Emergency Medicine
Deborah B Diercks, W Frank Peacock, Judd E Hollander, Adam J Singer, Robert Birkhahn, Nathan Shapiro, Ted Glynn, Richard Nowack, Basmah Safdar, Chadwick D Miller, Elizabeth Lewandrowski, John T Nagurney
BACKGROUND: Guidelines recommend that serial cardiac marker testing to rule out acute myocardial infarction (AMI) be performed for 8 to 12 hours after symptom onset. We aim to determine the diagnostic accuracy of a contemporary point-of-care (POC) troponin I (TnI) assay within 3 hours for patients presenting within 8 hours of symptom onset. METHODS: The MIDAS study collected blood from patients presenting with suspected acute coronary syndrome at presentation and at 90 minutes, 3 hours, and 6 hours in whom the emergency physician planned an objective cardiac ischemia evaluation...
January 2012: American Heart Journal
Patrick Fitzgerald, Steve W Goodacre, Elizabeth Cross, Simon Dixon
OBJECTIVES: Chest pain due to suspected myocardial infarction (MI) is responsible for many hospital admissions and consumes substantial health care resources. The Randomized Assessment of Treatment using Panel Assay of Cardiac markers (RATPAC) trial showed that diagnostic assessment using a point-of-care (POC) cardiac biomarker panel consisting of CK-MB, myoglobin, and troponin increased the proportion of patients successfully discharged after emergency department (ED) assessment. In this economic analysis, the authors aimed to determine whether POC biomarker panel assessment reduced health care costs and was likely to be cost-effective...
May 2011: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
Steve W Goodacre, Mike Bradburn, Elizabeth Cross, Paul Collinson, Alasdair Gray, Alistair S Hall
OBJECTIVES: To determine whether using a point-of-care cardiac biomarker panel would increase the rate of successful discharge home after emergency department assessment, and affect the use of cardiac tests and treatments, subsequent attendance at or admission to hospital and major adverse events. DESIGN AND SETTING: Pragmatic multicentre randomised controlled trial in six acute hospitals in the UK. PARTICIPANTS: Patients attending with acute chest pain due to suspected myocardial infarction (N=2243)...
February 2011: Heart: Official Journal of the British Cardiac Society
Adam J Singer, Joshua Ardise, Janet Gulla, Julie Cangro
STUDY OBJECTIVE: We determine the effect of cardiac troponin I point-of-care testing on emergency department (ED) length of stay in chest pain patients. METHODS: This was a before-and-after trial in a university-based ED with 75,000 annual visits. Participants were consecutive patients with a chief complaint of chest pain who were admitted to the hospital. During the first 2-week period (before), only central laboratory testing of troponin was performed. During the second 2-week period (after), treating nurses performed bedside point-of-care testing for troponin I, as well as central laboratory testing...
June 2005: Annals of Emergency Medicine
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