Department of Emergency Medicine, St Paul's Hospital and the University of British Columbia, Vancouver, BC, Canada.
Center for Advancing Health Outcomes, Vancouver, BC, Canada.
CJEM. 2024 Nov;26(11):814-818. doi: 10.1007/s43678-024-00778-1. Epub 2024 Oct 28.
For emergency department (ED) patients with cardiac chest pain, introduction of high-sensitivity troponin (hsTnT) pathways has been associated with reductions in length of stay of less than 1 h.
At two urban Canadian sites, we introduced hsTnT on January 26, 2016. While the prior diagnostic algorithm required troponin testing at 0 and 6 h, serial hsTnT serial testing was conducted at 0 and 3 h. We identified consecutive patients who presented with cardiac chest pain from January 1, 2015, to March 31, 2017, along with 30-day outcomes. The primary outcome was a missed 30-day major adverse cardiac event, (MACE) defined as death, revascularization, or readmission for myocardial infarction occurring in a patient-discharged home with a minimizing diagnosis and without cardiac-specific follow-up. Secondary outcomes included admission rate, ED length of stay, and MACE. We compared pre- and post- implementation periods using descriptive methods and repeated this analysis in patients with noncardiac chest pain.
We collected 5585 patients with cardiac chest pain, (2678 pre- and 2907 post-introduction) and 434 had (7.8%, 95% CI 7.1 to 8.5%) MACE, with 1 missed MACE. (0.2%, 95% CI 0.04 to 1.3%). Admission rate was stable at 24.1% pre- and 23.7% while median length of stay decreased from 464 to 285 min, a difference of 179 min. (95% CI 61 to 228 min). For 11,611 patients with noncardiac chest pain, admission rate (9%) and length of stay (191 versus 193 min) remained constant.
Implementation of hsTnT for evaluation of ED chest pain patients was safe and associated with a 3-h decrease in length of stay.
对于急诊科（ED）出现心前区疼痛的患者，引入高敏肌钙蛋白（hsTnT）检测路径与住院时间减少不到 1 小时有关。
在加拿大的两个城市，我们于 2016 年 1 月 26 日引入 hsTnT。在之前的诊断算法中，要求在 0 小时和 6 小时进行肌钙蛋白检测，而连续 hsTnT 连续检测则在 0 小时和 3 小时进行。我们确定了 2015 年 1 月 1 日至 2017 年 3 月 31 日期间连续出现心前区疼痛的患者，并对其 30 天结局进行了评估。主要结局为错过 30 天主要不良心脏事件（MACE），定义为出院回家的患者发生死亡、血运重建或因心肌梗死再入院，且诊断最小化，无心脏专科随访。次要结局包括入院率、ED 住院时间和 MACE。我们使用描述性方法比较了实施前后的情况，并在非心前区疼痛患者中重复了这一分析。
我们共收集了 5585 例心前区疼痛患者（2678 例为实施前，2907 例为实施后），其中 434 例（7.8%，95%CI7.1%至 8.5%）发生 MACE，1 例漏诊（0.2%，95%CI0.04%至 1.3%）。入院率在实施前为 24.1%，实施后为 23.7%，保持稳定，而中位住院时间从 464 分钟降至 285 分钟，相差 179 分钟（95%CI61 分钟至 228 分钟）。对于 11611 例非心前区疼痛患者，入院率（9%）和住院时间（191 分钟与 193 分钟）保持不变。
hsTnT 用于评估急诊科胸痛患者是安全的，并与住院时间减少 3 小时有关。
