A Multicenter Randomized Controlled Trial Comparing Central Laboratory and Point-of-Care Cardiac Marker Testing Strategies: The Disposition Impacted by Serial Point of Care Markers in Acute Coronary Syndromes (DISPO-ACS) Trial - 18/09/13
, Christopher J. Lindsell, PhD a, Judd E. Hollander, MD b, Brian O'Neil, MD c, Raymond Jackson, MD c, Donald Schreiber, MD d, Robert Christenson, PhD e, W. Brian Gibler, MD a
Address for correspondence: Richard J. Ryan, MD, Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH 45267; 513-558-8104, fax 513-558-5791Résumé |
Study objective |
Point-of-care testing reduces time to cardiac marker results in patients evaluated for acute coronary syndromes, yet evidence this translates to a decreased length of stay is lacking. We hypothesized that point-of-care testing decreases length of stay in patients being evaluated for acute coronary syndromes in the emergency department (ED).
Methods |
Patients being evaluated for possible acute coronary syndromes at 4 EDs in the United States were randomized to having point-of-care markers as well as central laboratory markers, or central laboratory markers only (laboratory arm). Point-of-care markers were obtained using early serial testing at presentation and at 90, 180, and 360 minutes as required by the treating physician. Evaluation, treatment, and disposition decisions were at the treating physician's discretion. Length of stay was from presentation to the time of departure from the ED, either to an inpatient setting or to home.
Results |
There were 1,000 patients in each study arm. There were 520 patients discharged home from the ED. Median (interquartile range) time to discharge home was 4.6 hours (3.5 to 6.1 hours) in laboratory patients and 4.5 hours (3.5 to 6.1 hours) in point-of-care patients. Median (interquartile range) time to transfer to an inpatient setting for admitted patients was 5.5 hours (4.2 to 7.5 hours) in laboratory patients, and 5.4 hours (4.1 to 7.3 hours) in point-of-care patients. At one site, time to transfer to the floor was reduced in the point-of-care arm compared with the laboratory arm (difference in medians 0.45 hours; 95% confidence interval [CI] –0.14 to 1.04 hours). At one site, time to ED departure for discharged patients was higher in the point-of-care arm than the laboratory arm (difference in medians 1.25 hours; 95% CI 0.13 to 2.36 hours).
Conclusion |
The effect of point-of-care testing on length of stay in the ED varies between settings. At one site, point-of-care testing decreased time to admission, whereas at another, point-of-care testing increased time to discharge. Potential effects of point-of-care testing on patient throughput should be considered in the full context of ED operations.
Le texte complet de cet article est disponible en PDF.Plan
| Supervising editor: Donald M. Yealy, MD |
|
| Dr. Yealy was the supervising editor on this article. Dr. Hollander did not participate in the editorial review or decision to publish this article. |
|
| Author contributions: All authors contributed to the conception and design of this study. WBG was responsible for obtaining funding. Data were collected by RJR, JEH, BO, RJ, and DS. CJL was responsible for data management and analysis. All authors were involved in the interpretation of the data. RJR and CJL drafted the article, and all authors provided critical feedback. RJR takes responsibility for the paper as whole. |
|
| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was funded in part by i-STAT/Abbott POC. The funding agency had no control over the study design, data collection, data analysis or interpretation and presentation of results. CJL and RJR have received research grants from Abbott POC. |
|
| Publication dates: Available online August 8, 2008. |
|
| Reprints not available from the authors. |
Vol 53 - N° 3
P. 321-328 - mars 2009 Retour au numéro
Article précédent
- One-Year Medical Outcomes and Emergency Department Recidivism After Emergency Department Observation for Cocaine-Associated Chest Pain
- Rebecca Cunningham, Maureen A. Walton, Jim Edward Weber, Samantha O'Broin, Shanti P. Tripathi, Ronald F. Maio, Brenda M. Booth
- Clevidipine, an Intravenous Dihydropyridine Calcium Channel Blocker, Is Safe and Effective for the Treatment of Patients With Acute Severe Hypertension
- Charles V. Pollack, Joseph Varon, Norman A. Garrison, Ramin Ebrahimi, Lala Dunbar, W. Frank Peacock
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?