The Impact of an Accelerated Diagnostic Protocol Using Conventional Troponin I for Patients With Cardiac Chest Pain in the Emergency Department

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Jesse Hill MD, MSc , Esther H. Yang BSc, MSc , Dennis Lefebvre MD, PhD , Shandra Doran MD, PhD , Sean van Diepen MD, FRCPC , Joshua E. Raizman PhD , Albert K.Y. Tsui PhD , Brian H. Rowe MD, MSc
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引用次数: 0

Abstract

Background

This study strove to assess the impact of the implementation of an accelerated diagnostic protocol (ADP), using shortened serial-testing intervals and a conventional troponin I (c-TnI) test, on emergency department (ED) length of stay (LOS).

Methods

This retrospective cohort study included adults (aged ≥ 18 years) presenting to a Canadian ED with a primary complaint of cardiac chest pain between January 14, 2017 and January 15, 2019. For non-high-risk patients, the troponin delta timing decreased from 6 hours to 3 hours, and a different conventional troponin I level cut-point was implemented on January 15, 2018. The primary outcome was ED LOS. Secondary outcomes included disposition status, consultation proportions, and major adverse cardiac events within 30 days.

Results

A total of 3133 patient interactions were included. Although the overall decrease in median ED LOS was not significant (P = 0.074), a significant reduction occurred in ED LOS (-33 minutes; 95% confidence interval: -53.6 to -12.4 minutes) among patients who were discharged in the post-ADP group. Consultations were unchanged between groups (36.1% before vs 33.8% after; P = 0.17). The major adverse cardiac events outcomes were unchanged across cohorts (15.9% vs 15.3%; P = 0.62).

Conclusions

The implementation of an ADP, with a conventional troponin I test, for cardiac chest pain in a Canadian ED was not associated with a significant reduction of LOS for all patients; however, a significant reduction occurred for patients who were discharged, and the strategy appears safe.

使用常规肌钙蛋白 I 的加速诊断方案对急诊科心源性胸痛患者的影响
背景本研究旨在评估加速诊断方案(ADP)的实施对急诊科(ED)住院时间(LOS)的影响,该方案采用缩短的连续检测时间间隔和常规肌钙蛋白 I(c-TnI)检测。方法这项回顾性队列研究纳入了 2017 年 1 月 14 日至 2019 年 1 月 15 日期间以心脏胸痛为主诉到加拿大一家急诊科就诊的成人(年龄≥ 18 岁)。对于非高风险患者,肌钙蛋白δ时间从6小时降至3小时,并于2018年1月15日实施了不同的常规肌钙蛋白I水平切点。主要结果是 ED LOS。次要结果包括处置状态、就诊比例和 30 天内的主要心脏不良事件。虽然 ED LOS 中位数的总体下降幅度不大(P = 0.074),但 ADP 后组出院患者的 ED LOS 显著缩短(-33 分钟;95% 置信区间:-53.6 至 -12.4 分钟)。各组之间的就诊率没有变化(就诊前为 36.1%,就诊后为 33.8%;P = 0.17)。结论在加拿大的一家急诊室对心脏性胸痛实施 ADP 和常规肌钙蛋白 I 检测并不能显著缩短所有患者的 LOS,但出院患者的 LOS 显著缩短,而且该策略似乎是安全的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CJC Open
CJC Open Medicine-Cardiology and Cardiovascular Medicine
CiteScore
3.30
自引率
0.00%
发文量
143
审稿时长
60 days
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