Comparison of Point-of-Care Versus Laboratory Troponin Testing in an Emergency Department Setting

Abstract

Background: There have been concerns regarding troponin results accuracy between point-of-care (POC) testing preformed in an emergency department (ED) setting and laboratory testing. The purpose of this study was to compare the results of cardiac troponin I testing as concerns POC testing and laboratory analysis as a way to show that these results are interchangeable. Methods: A retrospective chart review was performed from October 2012 through September 2013 to identify all patients who presented to the ED that received both a POC and laboratory troponin associated with the same blood draw. Findings: A total of 189 patients met inclusion criteria. Three laboratory samples were hemolyzed and not available for comparison. Of the remaining 186 samples, when a positive cutoff value of 0.034 ng/mL was used: 37 POC tests were positive and 149 POC tests were negative, sensitivity 0.85 (95% confidence interval [CI] = 0.69-0.94), specificity 0.98 (95% CI = 0.94-0.99), positive predictive value 91.9% (95% CI = 77-97.9%), and negative predictive value 96% (95% CI = 91.1-98.4%). When a POC troponin positive cutoff value of 0.12 ng/mL was used: 20 POC tests were positive and 164 were negative: sensitivity 1.0 (95% CI = 0.8-1.0), specificity 0.99 (95% CI = 0.95-1.0), positive predictive value 91% (95% CI = 69-98.4%), and negative predictive value 100% (95% CI = 97.1-100%). Discussion: In an ED setting; POC testing is accurate and correlates well with laboratory testing. Considering that the POC analysis takes a fraction of time to yield results, the validity of its data is important. The results of this study show that the POC system is a suitable test for rapid evaluation of patients presenting to the ED. This correlation increased with a higher testing positive cutoff value (0.12 versus 0.034 ng/mL). These data can assist the emergency physician with rapid identification of evidence of cardiac injury and be assured that the results are accurate. Recommendations: POC lab testing should be considered whenever possible to provide the fastest troponin results.

Analytical Evaluation of Cardiac Poct: Humasis Hubi-Quanpro Troponin I

“…The POCT system is the appropriate way of test for rapid evaluation of patient presenting with acute coronary syndrome (Juliano & Wason 2017). According to the results, it is proven that HUBI-QUANPro troponin I was able to provide result at ~15 minutes interval which meets the POCT advantages of providing cardiac troponin result at shorter interval that has potential in improving the acute patient care and enabling rapid clinical decision.…”

Point-of-Care Diagnosis of Acute Myocardial Infarction in Central Vietnam

“… 38 Others showed the practical utility of POC cTn for patients presenting to the emergency department. 39 , 40 Japanese authors recently assessed the usefulness of POC cTn in the emergency department. 41 A POC study conducted in an emergency department in Taiwan demonstrated the advantages of using multiple cardiac biomarkers to improve diagnosis of elderly and female patients, 42 challenging groups for diagnosis, who would benefit in Vietnam.…”

Modern diagnostics in emergency medicine

“…Secretion samples and smears can likewise provide clinically essential information; widely used guaiac-based stool-blood tests allow instant detection of fecal occult blood in human stool (e.g. in patients presenting to the ED with anemia of unknown origin) [13][14][15][16][17]. Nasopharyngeal specimens can be examined for the presence of Influenza A and B virus nucleoprotein antigens [18], respiratory syncytial fusion protein or Streptococcus pyogenes group A antigens within minutes.…”

“…A score of ≥3 points has a high specificity (98%), but low sensitivity for the presence of myocardial infarction [15,16]. The modified method according to Smith et al uses a ST/S ratio of >0.25 as an equivalent for excessive discordance (Sgarbossa's criterion C, see above), which further improves diagnostic precision [21].…”