Evaluation of quantitative cardiac biomarker point-of-care testing in the emergency department

Caragher, Timothy E.; Fernandez, Balbino B.; Jacobs, Fred L; Barr, L.A.

doi:10.1016/s0736-4679(01)00429-2

Cited by 40 publications

(21 citation statements)

References 12 publications

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“…Newby et al 9 demonstrated earlier identification of myocardial infarction than laboratory testing and Carragher et al 10 showed expedited decision-making with turnaround times reduced by 55%, but it was not clear whether these led to meaningful changes in patient care. Ng et al 11 compared management with the panel to previous practice and showed a 40% reduction in coronary care unit admissions.…”

Section: Discussionmentioning

confidence: 99%

“…The combination of cardiac troponin, CK-MB and myoglobin measured by point-of-care testing at baseline and 90 min later has been widely evaluated and used. Diagnostic cohort studies of this combination report high sensitivity for myocardial infarction7–14 and before-and-after intervention studies suggest its use can reduce turnaround times10 and coronary care unit admissions 11. However, there have been no randomised controlled trials of this diagnostic strategy to determine reliably whether it can change patient management and reduce hospital admissions.…”

mentioning

confidence: 99%

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The Randomised Assessment of Treatment using Panel Assay of Cardiac Markers (RATPAC) trial: a randomised controlled trial of point-of-care cardiac markers in the emergency department

Goodacre

Bradburn²,

Cross³

et al. 2010

Heart

124

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Objectives To determine whether using a point-of-care cardiac biomarker panel would increase the rate of successful discharge home after emergency department assessment, and affect the use of cardiac tests and treatments, subsequent attendance at or admission to hospital and major adverse events. Design and setting Pragmatic multicentre randomised controlled trial in six acute hospitals in the UK. Participants Patients attending with acute chest pain due to suspected myocardial infarction (N¼2243).Interventions Diagnostic assessment using a point-ofcare biomarker panel consisting of creatine kinase, myocardial type, myoglobin and troponin I measured at baseline and 90 min compared with standard care without the point-of-care panel.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

The Randomised Assessment of Treatment using Panel Assay of Cardiac Markers (RATPAC) trial: a randomised controlled trial of point-of-care cardiac markers in the emergency department

Goodacre

Bradburn²,

Cross³

et al. 2010

Heart

124

View full text Add to dashboard Cite

show abstract

“…Numerous authors refer to the high sensitivity and specificity in clinical practice of cTnI, which according to Caragher et al [31], reaches 100%. In forensic research there are few references to the diagnostic efficacy of the markers we study.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic efficacy of biochemical markers in diagnosis post-mortem of ischaemic heart disease

Pérez-Cárceles

Noguera

Jiménez

et al. 2004

Forensic Science International

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“…Of the included studies, three were rated “Good” quality and five were rated “Fair” quality. The effect size of two studies that measured TAT [41][59] were rated “Substantial”, and one study that measured length of stay (LOS) [59] was rated “Minimal/None”. The results are suggestive of decreased TAT with POCT practice implementation.…”

Section: 0 Evidence Review Synthesis and Resultsmentioning

confidence: 99%

Effectiveness of practices for improving the diagnostic accuracy of Non ST Elevation Myocardial Infarction in the Emergency Department: A Laboratory Medicine Best Practices™ systematic review

Layfield

Rose

Alford

et al. 2015

Clinical Biochemistry

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Objectives This article presents evidence from a systematic review of the effectiveness of four practices (assay selection, decision point cardiac troponin (cTn) threshold selection, serial testing, and point of care testing) for improving the diagnostic accuracy for Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) in the Emergency Department. Design and Methods The CDC-funded Laboratory Medicine Best Practices (LMBP™) Initiative systematic review A6 Method for Laboratory Best Practices was used. Results The current guidelines (e.g., ACC/AHA) recommend using cardiac troponin assays with a 99th percentile upper reference limit (URL) diagnostic threshold to diagnose NSTEMI. The evidence in this systematic review indicates that contemporary sensitive cTn assays meet the assay profile requirements (sensitivity, specificity, PPV, and NPV) to more accurately diagnose NSTEMI than alternate tests. Additional biomarkers did not increase diagnostic effectiveness of cTn assays. Sensitivity, specificity, and negative predictive value (NPV) were consistently high and low positive predictive value (PPV) improved with serial sampling. Evidence for use of cTn point of care testing (POCT) was insufficient to make recommendations, though some evidence suggests cTn POCT may result in reduction to patient length of stay and costs. Conclusions Two best practice recommendations emerged from the systematic review and meta-analysis of literature conducted using the LMBP™ A6 Method criteria: Testing with cardiac troponin assays, using the 99th percentile URL as the clinical diagnostic threshold for the diagnosis of NSTEMI and without additional biomarkers, is recommended. Also recommended is serial cardiac troponin sampling with one sample at presentation and at least one additional sample taken a minimum of 6 hours later to identify a rise or fall in the troponin level. Testing with high-sensitivity cardiac troponin assays, at presentation and again within 6 hours, is the recommended evidence-based best practice testing algorithm for optimized NSTEMI diagnosis.

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Evaluation of quantitative cardiac biomarker point-of-care testing in the emergency department

Cited by 40 publications

References 12 publications

The Randomised Assessment of Treatment using Panel Assay of Cardiac Markers (RATPAC) trial: a randomised controlled trial of point-of-care cardiac markers in the emergency department

The Randomised Assessment of Treatment using Panel Assay of Cardiac Markers (RATPAC) trial: a randomised controlled trial of point-of-care cardiac markers in the emergency department

Diagnostic efficacy of biochemical markers in diagnosis post-mortem of ischaemic heart disease

Effectiveness of practices for improving the diagnostic accuracy of Non ST Elevation Myocardial Infarction in the Emergency Department: A Laboratory Medicine Best Practices™ systematic review

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