Biomarker validation in the emergency department. General criteria and clinical implications

Abstract

The routine use of biomarkers, which is also rapidly expanding in the emergency department, carries some potential drawbacks such as the risk of producing false positive results and also places a substantial economical burden on the healthcare system, especially when the use of laboratory resources is poorly discretionary or even inappropriate. The aim of this article is to provide an overview about some general criteria for biomarker validation in the emergency department, and discuss some relevant clinical implications. The leading aspects include analysis of data distribution and diagnostic performance, along with economical and organizational issues. We also brought a pragmatic example, comparing creatine kinase MB, a contemporary-sensitive troponin I and a high-sensitivity troponin I immunoassays for evaluation of patients with suspected acute myocardial infarction at emergency department admission.

Trends of popularity of cardiac biomarkers: Insights from Google Trends

“…23 However, the real practice is often different from the theory. Many clinicians may be persuaded that the larger is the panel of laboratory tests requested, the less likely is the chance of missing a diagnosis, 24,25 especially for medical conditions with the highest number of malpractice claims, such as AMI. 26 This does not hold true, however, as recently emphasized by Alvin et al, 7 wherein inappropriate or unjustified prescription of obsolete cardiac biomarkers (especially CK-MB) is associated with otherwise preventable healthcare expenditure, no added value for patient care, but also with the risk of generating false positive test results, which might then trigger unwarranted and even invasive diagnostic investigations (e.g., angiography).…”