Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): Liverpool University Hospitals NHS Foundation Trust
Background
There have been relatively few studies detailing the real-world effectiveness and safety of accelerated diagnostic protocols (ADP), using high sensitivity troponins (HSTN).
Purpose
To analyse the safety and effectiveness of early emergency room (ER) discharge following implementation of the ESC 0/3-hour ADP for suspected acute coronary syndromes (ACS)
Method
We prospectively studied 2 cohorts of consecutive suspected acute coronary syndromes (ACS) presentations to ER before (n = 1642) and after (n = 1376, 2 centres) implementation of the ESC 0/3-hour ADP incorporating limit of detection rule out. All index presentations with HSTNT (high sensitive troponin T) >99th percentile underwent independent two physician adjudication for MI (myocardial infarction) using all available data to six weeks. Safety was defined by both NPV (negative predictive value) and sensitivity for type 1 or type 2 MI for those with ER discharge and clinical effectiveness by percentage ER discharge.
Results
In the pre-implementation period there was a higher prevalence of MI. Discharge from ER increased by >100% to 56% of the cohort, when the ADP was implemented. This correlated with a marked reduction in length of stay overall and a more modest reduction for those discharged from ER (table)
The greatly increased ER discharge was safe with no signal for hazard.
Analysis of HSTNT values and ECGS revealed a maximum ER discharge rate of 69%, by applying the 0/3-hour protocol, implying potential for further increasing safe ER discharge.
Conclusions
Implementation of an ADP with HSTNs is safe and effective for early rule-out and discharge of suspected ACS. Further research into the shortfall between theoretical and actual early ER discharge achieved is warranted.
Type of funding sources: Other. Main funding source(s): Liverpool University Hospitals NHS Foundation Trust
Background
There have been relatively few studies detailing the real-world effectiveness and safety of accelerated diagnostic protocols (ADP), using high sensitivity troponins (HSTN).
Purpose
To analyse the safety and effectiveness of early emergency room (ER) discharge following implementation of the ESC 0/3-hour ADP for suspected acute coronary syndromes (ACS)
Method
We prospectively studied 2 cohorts of consecutive suspected acute coronary syndromes (ACS) presentations to ER before (n = 1642) and after (n = 1376, 2 centres) implementation of the ESC 0/3-hour ADP incorporating limit of detection rule out. All index presentations with HSTNT (high sensitive troponin T) >99th percentile underwent independent two physician adjudication for MI (myocardial infarction) using all available data to six weeks. Safety was defined by both NPV (negative predictive value) and sensitivity for type 1 or type 2 MI for those with ER discharge and clinical effectiveness by percentage ER discharge.
Results
In the pre-implementation period there was a higher prevalence of MI. Discharge from ER increased by >100% to 56% of the cohort, when the ADP was implemented. This correlated with a marked reduction in length of stay overall and a more modest reduction for those discharged from ER (table)
The greatly increased ER discharge was safe with no signal for hazard.
Analysis of HSTNT values and ECGS revealed a maximum ER discharge rate of 69%, by applying the 0/3-hour protocol, implying potential for further increasing safe ER discharge.
Conclusions
Implementation of an ADP with HSTNs is safe and effective for early rule-out and discharge of suspected ACS. Further research into the shortfall between theoretical and actual early ER discharge achieved is warranted.
| Original language | English |
|---|---|
| Journal | European heart journal. Acute cardiovascular care |
| DOIs | |
| Publication status | Published - 26 Apr 2021 |