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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The primary outcome was ED LOS. Secondary outcomes included disposition status, consultation proportions, and major adverse cardiac events within 30 days.</p></div><div><h3>Results</h3><p>A total of 3133 patient interactions were included. Although the overall decrease in median ED LOS was not significant (<em>P</em> = 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; <em>P</em> = 0.17). The major adverse cardiac events outcomes were unchanged across cohorts (15.9% vs 15.3%; <em>P</em> = 0.62).</p></div><div><h3>Conclusions</h3><p>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.</p></div>","PeriodicalId":36924,"journal":{"name":"CJC Open","volume":"6 7","pages":"Pages 915-924"},"PeriodicalIF":2.5000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2589790X24001409/pdfft?md5=c44c3b996ffcc2926e5ce9404a03bec2&pid=1-s2.0-S2589790X24001409-main.pdf","citationCount":"0","resultStr":"{\"title\":\"The Impact of an Accelerated Diagnostic Protocol Using Conventional Troponin I for Patients With Cardiac Chest Pain in the Emergency Department\",\"authors\":\"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\",\"doi\":\"10.1016/j.cjco.2024.03.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>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).</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>A total of 3133 patient interactions were included. Although the overall decrease in median ED LOS was not significant (<em>P</em> = 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; <em>P</em> = 0.17). The major adverse cardiac events outcomes were unchanged across cohorts (15.9% vs 15.3%; <em>P</em> = 0.62).</p></div><div><h3>Conclusions</h3><p>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.</p></div>\",\"PeriodicalId\":36924,\"journal\":{\"name\":\"CJC Open\",\"volume\":\"6 7\",\"pages\":\"Pages 915-924\"},\"PeriodicalIF\":2.5000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2589790X24001409/pdfft?md5=c44c3b996ffcc2926e5ce9404a03bec2&pid=1-s2.0-S2589790X24001409-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"CJC Open\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2589790X24001409\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"CJC Open","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589790X24001409","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
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。
The Impact of an Accelerated Diagnostic Protocol Using Conventional Troponin I for Patients With Cardiac Chest Pain in the Emergency Department
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.