Impact of high-sensitivity cardiac troponin implementation on emergency department length of stay, testing, admissions, and diagnoses

James S. Ford, Ernestine Chaco, Daniel J. Tancredi, Bryn Mumma

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: While high-sensitivity (hs) troponin (cTn) has been associated with shorter emergency department (ED) length of stay (LOS) and decreased hospital admissions outside the United States (US), concerns have been raised that it will have opposite effects in the US. In this study, we aimed to compare ED LOS, admissions, and acute coronary syndrome (ACS) diagnoses before and after the implementation of hs-cTn. Methods: We conducted a single-institution, retrospective study of two temporally matched six-month study periods before and after the implementation of hs-cTn. We included consecutive adults presenting with chest pain. The primary outcome was ED LOS, which was log transformed and analyzed using multiple linear regression. Binary secondary outcomes of admissions, cardiac testing, cardiology consultation, and ACS diagnoses were analyzed using multiple logistic regression. Results: We studied 1589 visits before and 1616 visits after implementation of hs-cTn. Median age and sex ratios were similar between study periods. Median ED LOS was longer in the post-implementation period [post: 384 (interquartile range, IQR 260–577) minutes; pre: 374 (IQR 250–564) minutes; adjusted geometric mean ratio 1.05; 95% confidence interval, CI 1.01–1.10)]. Admissions were lower in the post-implementation period [post: 24% (385/1616) vs. pre: 28% (447/1589); adjusted odds ratio, aOR 0.75 (95% CI 0.64–0.88)]. Cardiac risk stratification testing [pre: 9% (142/1589) vs post: 9% (144/1616); aOR 0.95 (95% CI 0.74–1.22)], cardiology consultation [pre: 13% (208/1589) vs post: 13% (207/1616); aOR 0.91 (95% CI 0.73–1.12)], and ACS diagnoses [pre: 7% (116/1589) vs post: 7% (120/1616); aOR 0.94 (95% CI 0.72–1.24)] were similar between the two study periods. Conclusion: In this single-center study, transition to hs-cTn was associated with an increased ED LOS, decreased admissions, and no substantial change in cardiac risk stratification testing, cardiology consultation, or ACS diagnoses.

Original languageEnglish (US)
Pages (from-to)54-60
Number of pages7
JournalAmerican Journal of Emergency Medicine
Volume45
DOIs
StatePublished - Jul 2021

Keywords

  • Acute coronary syndrome
  • Chest pain
  • High-sensitivity troponin
  • Myocardial infarction

ASJC Scopus subject areas

  • Emergency Medicine

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