Pabón Alexandra M Cruz, Pyles Eric, Peach Daniel, Ahmad Sarfraz, O'Brien Paul Blake, Kuhlman Michael, Steiner Sarah, Crown Lara, Purinton Elizabeth, Priano James
AdventhHealth Orlando, Pharmacy Department, Orlando, FL, USA.
AdventHealth Corporate, Clinical Innovation Department, Orlando, FL, USA.
Am J Med Open. 2025 May 15;14:100103. doi: 10.1016/j.ajmo.2025.100103. eCollection 2025 Dec.
BACKGROUND/PURPOSE: Chest pain is a common reason for ED visits. Implementing a HEART score-based algorithm previously increased early discharges by 99%. This study aims to determine if the transition from cTnT to hs-cTnT assays affected patient disposition rates.
This retrospective observational study was conducted in a multi-site hospital system. Adults presenting to the ED with chest pain and a low HEART score (≤3) between November 9, 2020, and November 10, 2022, were included. The primary outcome was the change in patient disposition. Secondary outcomes included length-of-stay (LOS), rates of provocative testing, ED returns, and major adverse cardiovascular events (MACE).
We evaluated 32,968 patients (17,173 in the cTnT group and 15,795 in the hs-cTnT group). Both groups had a similar median age, but the hs-cTnT group had a higher proportion of patients with baseline troponin elevations. The ED discharge rate was higher in the hs-cTnT group (87.5%) compared to the cTnT group (85.3%; 001), with a corresponding decrease in observation and inpatient admissions. Additionally, the implementation of hs-cTnT was associated with a reduced LOS and a decrease in patients undergoing further testing. Finally, there was a reduction in ED re-visits without a difference in 30- or 60-day MACE after the implementation of hs-cTnT.
Integration of hs-cTnT into our chest pain clinical pathway resulted in increased ED discharges, reduced LOS, and fewer additional tests without a change in MACE. This translates to a savings of almost 7,000 ED hours annually without compromising safety.
背景/目的：胸痛是急诊科就诊的常见原因。实施基于HEART评分的算法之前，早期出院率提高了99%。本研究旨在确定从肌钙蛋白T（cTnT）检测过渡到高敏肌钙蛋白T（hs-cTnT）检测是否会影响患者的处置率。
本回顾性观察研究在一个多中心医院系统中进行。纳入2020年11月9日至2022年11月10日期间因胸痛且HEART评分低（≤3）到急诊科就诊的成年人。主要结局是患者处置的变化。次要结局包括住院时间（LOS）、激发试验率、急诊科复诊率和主要不良心血管事件（MACE）。
我们评估了32968例患者（cTnT组17173例，hs-cTnT组15795例）。两组的中位年龄相似，但hs-cTnT组基线肌钙蛋白升高的患者比例更高。hs-cTnT组的急诊科出院率（87.5%）高于cTnT组（85.3%；P = 0.001），观察和住院入院相应减少。此外，hs-cTnT的实施与住院时间缩短以及接受进一步检查的患者减少有关。最后，hs-cTnT实施后急诊科复诊减少，30天或60天MACE无差异。
将hs-cTnT纳入我们的胸痛临床路径导致急诊科出院增加、住院时间缩短、额外检查减少，且MACE无变化。这意味着每年节省近7000个急诊科小时，同时不影响安全性。
