即时检验可缩短急诊科胸痛患者的住院时间。
Point-of-care testing reduces length of stay in emergency department chest pain patients.
作者信息
Singer Adam J, Ardise Joshua, Gulla Janet, Cangro Julie
机构信息
Department of Emergency Medicine, Stony Brook University, Stony Brook, NY 11794, USA.
出版信息
Ann Emerg Med. 2005 Jun;45(6):587-91. doi: 10.1016/j.annemergmed.2004.11.020.
STUDY OBJECTIVE
We determine the effect of cardiac troponin I point-of-care testing on emergency department (ED) length of stay in chest pain patients.
METHODS
This was a before-and-after trial in a university-based ED with 75,000 annual visits. Participants were consecutive patients with a chief complaint of chest pain who were admitted to the hospital. During the first 2-week period (before), only central laboratory testing of troponin was performed. During the second 2-week period (after), treating nurses performed bedside point-of-care testing for troponin I, as well as central laboratory testing. Test turnaround times, time from triage until calling in admissions, and time from triage until patients left the ED to be transferred to a floor (ED length of stay) were determined and compared between the 2 study periods. Comparisons between study periods are expressed as mean differences with 95% confidence intervals (CIs). A sample of 100 patients in each group had 90% power to detect a 1-hour difference in length of stay (2-tailed alpha=0.05).
RESULTS
There were 232 patients before and 134 after introduction of point-of-care testing. Mean age (SD) was 63 years (16 years), and 44% were female patients. Baseline characteristics were similar in both groups. The rate of positive troponins was also similar (9.5% versus 6.1%). ED length of stay was significantly reduced after introduction of point-of-care testing (5.2 hours [95% CI 4.6 to 5.8 hours] versus 7.1 hours [95% CI 6.6 to 7.7 hours]; mean difference 1.9 hours [95% CI 1.1 to 2.7 hours]). The time until the admission was called in to bed control was also significantly reduced by introducing point-of-care testing (2.7 hours [95% CI 2.4 to 3.1 hours] versus 4.7 hours [95% CI 4.3 to 5.0 hours]; mean difference 1.9 hours [95% CI 1.4 to 2.5 hours]). Point-of-care testing turnaround (14.8 minutes [95% CI 14.1 to 15.5 minutes]) was significantly shorter than for central laboratory testing (83 minutes [95% CI 77 to 89 minutes]; mean difference 68 minutes [95% CI 62 minutes to 74 minutes]). With central testing as the criterion standard, point-of-care testing had a sensitivity of 100% (95% CI 63% to 100%) and a specificity of 96% (95% CI 92% to 99%).
CONCLUSION
Bedside performance of troponin I point-of-care testing by treating nurses significantly reduces ED length of stay.
研究目的
我们确定心肌肌钙蛋白I即时检测对胸痛患者在急诊科（ED）停留时间的影响。
方法
这是一项在一所大学附属医院急诊科进行的前后对照试验，该急诊科年就诊量为75000人次。研究对象为因胸痛为主诉而入院的连续患者。在第一个为期2周的时间段（之前），仅进行肌钙蛋白的中心实验室检测。在第二个为期2周的时间段（之后），负责治疗的护士进行肌钙蛋白I的床边即时检测以及中心实验室检测。确定并比较两个研究时间段的检测周转时间、从分诊到呼叫住院的时间以及从分诊到患者离开急诊科转至病房的时间（ED停留时间）。研究时间段之间的比较以95%置信区间（CI）的均值差异表示。每组100例患者的样本有90%的把握度检测出停留时间1小时的差异（双侧α = 0.05）。
结果
引入即时检测前有232例患者，引入后有134例患者。平均年龄（标准差）为63岁（16岁），44%为女性患者。两组的基线特征相似。肌钙蛋白阳性率也相似（9.5%对6.1%）。引入即时检测后，ED停留时间显著缩短（5.2小时[95%CI 4.6至5.8小时]对7.1小时[95%CI 6.6至7.7小时]；均值差异1.9小时[95%CI 1.1至2.7小时]）。引入即时检测后，呼叫住院至床位安排的时间也显著缩短（2.7小时[95%CI 2.4至3.1小时]对4.7小时[95%CI 4.3至5.0小时]；均值差异1.9小时[95%CI 1.4至2.5小时]）。即时检测周转时间（14.8分钟[95%CI 14.1至15.5分钟]）显著短于中心实验室检测（83分钟[95%CI 77至89分钟]；均值差异68分钟[95%CI 62分钟至74分钟]）。以中心实验室检测作为标准对照，即时检测的灵敏度为100%（95%CI 63%至100%），特异度为96%（95%CI 92%至99%）。
结论
负责治疗的护士进行肌钙蛋白I床边即时检测可显著缩短ED停留时间。
Zotero 插件