Quantitative Point-of-Care Troponin I in Emergency Department in Comparison With Troponin I in Central Laboratory

Point-of-Care Cardiac Troponin Testing as a Timely and Cost Effective Measure in Diagnosis of Acute Myocardial Infarction

“…In a large secondary analysis of a prospective, multicenter, blinded observational cohort study of 18 academic EDs, Diercks et al (2011) reported that the cTn POCT is diagnostically suitable for bedside usage and has testing characteristics similar to traditional laboratory platforms. Mozina et al (2010) reported similar findings regarding diagnostic accuracy of cTn POCT results compared to central laboratory results. They reported that the POCT assay showed analytical reliability in concordance with the guidelines of the European Society of Cardiology, American College of Cardiology, and the National Academy of Clinical Biochemistry (Mozina et al, 2010).…”

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

“…Three studies [37][52][53] were eliminated, after a thorough review, because they did not directly address the diagnostic threshold question. One study [41] was rated as “Fair” quality with “Minimal/None” effect and three published studies [38] [51][54] and one unpublished study [42] were rated “Good” quality with a “Moderate” effect size, for a total of five studies included in the practice effectiveness body of evidence.…”

“…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.…”

“…While POCT cTn has the potential to reduce TAT [59][41], and LOS [60], the body of evidence regarding this practice was insufficient and inconsistent for conclusions. However, there is sufficient published evidence to determine the equivalency of POCT assays to laboratory assays and we recommend additional studies be conducted to measure the effect of POCT cTn implementation.…”

“…) Unpublished studies included:  2 total − 0 = 2 Point of Care Testing 11 published studies Three studies [32][57][58] were excluded for failing to meet quality criteria. Other studies are reported as follows:  1 Study = Good/Moderate [38]  2 Studies = Good/Minimal [43][60]  3 Studies = 2, Fair/Substantial Pos [ 41][59];  1, Fair/Substantial Neg [61]  1 Study = Fair/Moderate [37]  1 Study = Fair/Minimal [62] Graphically represented as follows:    Eight studies reported inconsistent effects and direction. No recommendation was made.  Published studies included:  11 total − 3 = 8 Total Studies Included = 15 1 1 In this particular instance, authors use “studies” to denote “reports” or “articles.” 2 While Figure 2 is inclusive of all studies included for evaluation, several studies were removed for failing to meet a specific evaluation criterion or due to cTn assay issues. Published Studies Included = 4 + 4 + 5 = 13Unpublished Studies Included = 3 − 1 (2 analyses from same reference study) = 2Total Studies Included = 13 + 2 = 15 1 3 Later, authors use “studies” to denote practice “analyses”: For example, “A total of 24 published and 2 unpublished studies (Storrow 2014 [42] was unpublished at time of evaluation) were deemed acceptable for inclusion.” See section “3.0 Evidence review synthesis and results”(1) Six published studies contained data evaluating two practices.  Math: 15 1 + 6 extra analyses = 21 analyses(2) One unpublished study contained data evaluating two practices.  Math: 21 + 1 extra analysis = 22 analyses(3) Two published studies contained data evaluating three practices.  Math: 22 + 4 extra analyses =     26 Total Analyses …”