Journal article
A novel diagnostic protocol to identify patients suitable for discharge after a single high-sensitivity troponin
Heart, Vol.101(13), pp.1041-1046
2015
PMCID: PMC4484040
PMID: 25691511
Abstract
Objective To establish whether a novel accelerated diagnostic protocol (ADP) for suspected acute coronary syndrome (ACS) could successfully identify low-risk patients suitable for discharge after a single high-sensitivity troponin T (hs-cTnT) taken at presentation to the emergency department. We also compared the diagnostic accuracy of this ADP with strategies using initial undetectable hs-cTnT. Methods This prospective observational study evaluated the ability of the Triage Rule-out Using high-Sensitivity Troponin (TRUST) ADP to identify low-risk patients with suspected ACS. The ADP incorporated a single presentation hs-cTnT of < 14 ng/L, a non-ischaemic ECG and a modified Goldman risk score. Diagnostic performance of the ADP was compared with the detection limit cut-offs of hs-cTnT (?<5 ng/L and <3 ng/L). The primary end point was fatal/non-fatal acute myocardial infarction (AMI) within 30 days. Results 960 participants were recruited, mean age 58.0 years, 80 (8.3%) had an AMI. The TRUST ADP classified 382 (39.8%) as low-risk with a sensitivity for identifying AMI of 98.8% (95% CI 92.5% to 99.9%). hs-cTnT detection limits (<5 ng/L and <3 ng/L) had a sensitivity of 100% (94.3 to 100) and 100% (94.4 to 100), respectively. The TRUST ADP identified more patients suitable for early discharge at 39.8% vs 29.3% (<5 ng/L) and 7.9% (<3 ng/L) (p<0.001) with a lower false-positive rate for AMI detection; specificity 43.3% (95% CI 42.7% to 43.4%) vs 32.0% (95% CI 31.5% to 32.0%) and 8.6% (95% CI 8.1% to 8.6%), respectively. Conclusions The TRUST ADP, which incorporates structured risk-assessment and a single presentation hs-cTnT blood draw, has potential to allow early discharge in 40% of patients with suspected ACS and has greater clinical utility than undetectable hs-cTnT strategies.
Details
- Title
- A novel diagnostic protocol to identify patients suitable for discharge after a single high-sensitivity troponin
- Authors
- Edward W Carlton (Author) - Bournemouth University, United KingdomLouise Cullen (Author) - Royal Brisbane and Women's HospitalMartin Than (Author) - Christchurch Hospital, New ZealandJames Gamble (Author) - John Radcliffe Hospital, United KingdomAhmed Khattab (Author) - Bournemouth University, United KingdomKim Greaves (Author) - University of the Sunshine Coast - Faculty of Science, Health, Education and Engineering
- Publication details
- Heart, Vol.101(13), pp.1041-1046
- Publisher
- B M J Group
- Date published
- 2015
- DOI
- 10.1136/heartjnl-2014-307288
- ISSN
- 1355-6037
- PMID
- 25691511; PMC4484040
- Copyright note
- Copyright © 2015 The Authors. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
- Organisation Unit
- Faculty of Science, Health, Education and Engineering; University of the Sunshine Coast, Queensland
- Language
- English
- Record Identifier
- 99449399102621
- Output Type
- Journal article
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