Shinde Varsha, Dixit Yash, Penmetsa Pranay, Luthra Avinav
Department of Emergency Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed to be University), Pune, IND.
Department of Emergency Medicine, United Institute of Medical Sciences, Prayagraj, IND.
Cureus. 2024 Aug 9;16(8):e66512. doi: 10.7759/cureus.66512. eCollection 2024 Aug.
Evaluating high-sensitivity troponin I levels in emergency medicine is critical for diagnosing acute myocardial infarction (AMI). This study aims to evaluate the central laboratory versus bedside troponin I test in the emergency department of a tertiary care center.
This prospective observational study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, from October to December 2023. Patient samples were analyzed in the central laboratory using the Dimension EXL 200 (Siemens® Healthcare Diagnostics Inc., Erlangen, Germany) as the gold standard test and through point-of-care testing using the TriageTrue® (Quidel Corporation, San Diego, CA) high-sensitivity troponin I kit, which was run on the Triage® MeterPro® device (Quidel Corporation, San Diego, CA). This device quantitatively determines troponin I in ethylenediaminetetraacetic acid-anticoagulated whole blood and plasma specimens. The results were compared. Statistical analysis was performed using SPSS version 18 (SPSS Inc., Chicago, IL). An unpaired t-test was performed to compare the difference in time taken using the two testing methods.
The mean time for obtaining troponin I results was substantially shorter with bedside testing (14.91 minutes, standard deviation (SD) = 0.5) than with laboratory testing (119.1 minutes, SD = 5.03). Statistical analysis revealed a significant difference (t = -172.36, p < 0.001). A chi-square test was conducted to assess the disparity between the two testing methods, yielding a chi-square value of 32.64 and a p value of 0.00001, indicating a significant difference between bedside testing and laboratory testing.
The bedside high-sensitivity troponin I test offers a considerable advantage over laboratory testing regarding turnaround time within the emergency medicine department in India. This rapid diagnostic capability is crucial for timely management, which is beneficial for patients inconclusive of acute coronary syndrome-like non-ST segment elevation myocardial infarction (NSTEMI). It is also cost-effective. It also reduces the emergency boarding time and may reduce the number of unnecessary admissions in healthcare facilities.
评估急诊医学中的高敏肌钙蛋白I水平对于诊断急性心肌梗死（AMI）至关重要。本研究旨在评估三级医疗中心急诊科中央实验室检测与床旁肌钙蛋白I检测的效果。
本前瞻性观察性研究于2023年10月至12月在印度马哈拉施特拉邦浦那的D.Y.帕蒂尔医学院、医院和研究中心进行。患者样本在中央实验室使用Dimension EXL 200（西门子医疗诊断公司，德国埃尔兰根）作为金标准检测方法进行分析，并通过使用TriageTrue®（Quidel公司，加利福尼亚州圣地亚哥）高敏肌钙蛋白I检测试剂盒在Triage® MeterPro®设备（Quidel公司，加利福尼亚州圣地亚哥）上进行即时检测。该设备可定量测定乙二胺四乙酸抗凝全血和血浆样本中的肌钙蛋白I。对结果进行比较。使用SPSS 18版（SPSS公司，伊利诺伊州芝加哥）进行统计分析。采用不成对t检验比较两种检测方法所用时间的差异。
床旁检测获得肌钙蛋白I结果的平均时间（14.91分钟，标准差（SD）=0.5）比实验室检测（119.1分钟，SD =5.03）短得多。统计分析显示存在显著差异（t = -172.36，p <0.001）。进行卡方检验以评估两种检测方法之间的差异，卡方值为32.64，p值为0.00001，表明床旁检测与实验室检测之间存在显著差异。
在印度急诊科，床旁高敏肌钙蛋白I检测在周转时间方面比实验室检测具有相当大的优势。这种快速诊断能力对于及时治疗至关重要，这对疑似急性冠状动脉综合征样非ST段抬高型心肌梗死（NSTEMI）的患者有益。它还具有成本效益。它还减少了急诊滞留时间，并可能减少医疗机构中不必要的住院人数。
