184 Can Point of Care Be as Good as the Central Lab?

Peacock, W. Frank; Diercks, Deborah B.; Hollander, J.E.; Singer, Adam J.; Birkhahn, Robert; Shapiro, Nathan I.; Arnold, W. David; Noland, Brian M.J.; Nagurney, Justine M.

doi:10.1016/j.annemergmed.2011.06.212

Cited by 1 publication

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“…Troponin measures for the risk stratification strategies were performed centrally using the Triage Cardio3 TnI point of care platform (Alere, Waltham, MA) [15]. The reference value for this assay was determined using banked plasma samples from healthy controls.…”

Section: Methodsmentioning

confidence: 99%

Identifying patients for early discharge: Performance of decision rules among patients with acute chest pain

Mahler

Miller

Hollander

et al. 2013

International Journal of Cardiology

126

102

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Background The HEART score and North American Chest Pain Rule (NACPR) are decision rules designed to identify acute chest pain patients for early discharge without stress testing or cardiac imaging. This study compares the clinical utility of these decision rules combined with serial troponin determinations. Methods and Results A secondary analysis was conducted of 1005 participants in the Myeloperoxidase In the Diagnosis of Acute coronary syndromes Study (MIDAS). MIDAS is a prospective observational cohort of Emergency Department (ED) patients enrolled from 18 US sites with symptoms suggestive of acute coronary syndrome (ACS). The ability to identify participants for early discharge and the sensitivity for ACS at 30 days were compared among an unstructured assessment, NACPR, and HEART score, each combined with troponin measures at 0 and 3 hours. ACS, defined as cardiac death, acute myocardial infarction, or unstable angina, occurred in 22% of the cohort. The unstructured assessment identified 13.5% (95% CI 11.5-16%) of participants for early discharge with 98% (95% CI 95-99%) sensitivity for ACS. The NACPR identified 4.4% (95% CI 3-6%) for early discharge with 100% (95% CI 98-100%) sensitivity for ACS. The HEART score identified 20% (95% CI 18-23%) for early discharge with 99% (95% CI 97-100%) sensitivity for ACS. The HEART score had a net reclassification improvement of 10% (95% CI 8-12%) versus unstructured assessment and 19% (95% CI 17-21%) versus NACPR. Conclusions The HEART score with 0 and 3 hour serial troponin measures identifies a substantial number of patients for early discharge while maintaining high sensitivity for ACS.

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Section: Methodsmentioning

confidence: 99%