Improving Care with the First measurement of high-sensitivity troponin T (ICare-FirsT) to enable early rule out and reduce length of stay: a diagnostic and observational study.

Background: Pathways incorporating clinical risk assessment, ECG and serial troponin measurements for the assessment of patients with possible myocardial infarction (MI) in the ED are standard practice. Incorporating a single troponin test to stratify to low risk of MI using a baseline measurement of cardiac troponin (cTn) with a high-sensitivity T assay (hs-cTnT) is recommended. We aimed to implement a pathway incorporating a single-test component and measure the impact on length of stay (LOS).

Atrial fibrillation patients presenting to an emergency department successfully managed with a next-day community follow-up pathway: A before-and-after cohort study.

Objectives: To assess the effectiveness and safety of the new clinical pathway for patients presenting to an ED with AF, incorporating community next-working-day follow-up and more specific clinician guidance around medication prescribing.

Methods: A before-and-after, retrospective cohort study comparing patients presenting to Christchurch ED with acute uncomplicated AF in the year before ('hospital-based' follow-up) and after ('community-based' follow-up) implementation of a new AF management approach. The 'community' pathway replaced hospital-based review with a next-day community follow-up and introduced more specific anticoagulation recommendations.

"Are they going to recollect who they need to contact?": understanding sexually transmitted infection transmission risks among older Canadians who winter in the United States.

Background: Sexually transmitted infections are on the rise in older populations globally, including among older travellers. International retirement migrants are older people who have retired from the workforce and travel abroad seasonally, typically during the winter months in their home countries. The transnational nature of this practice may challenge public health efforts to control the spread of sexually transmitted infection and encourage treatment.

Evaluation of a virtual emergency care service to avoid unnecessary emergency department presentations and provide specialist-led definitive care.

Objective: A quantitative and qualitative evaluation of the impact of a peer-to-peer telehealth service called Specialist Telehealth Aotearoa (STAR) on transfers to the ED.

Methods: This mixed-methods study reviewed STAR between 31 July 2023 and 31 October 2023. Reasons for presentation and outcomes were analysed.

Potential length of stay reductions from emergency department use of a point-of-care high-sensitivity cardiac troponin assay: Pilot findings from Australia's first cardiac emergency department.

Objective: To compare actual ED length of stay (LOS) using laboratory-based high-sensitivity cardiac troponin I (hs-cTnI) testing with the potential LOS that could result from using point-of-care (POC) hs-cTnI tests.

Methods: Baseline hs-cTnI tests were performed on the same blood sample in the laboratory (Access hsTnI assay) and in the ED (Atellica VTLi POC assay). Actual and potential LOS were compared for patients who were discharged after having a baseline laboratory hs-cTnI test only.

Mild and moderate traumatic brain injury: Screening, documentation, and referral to concussion services.

Background And Aim: Screening of traumatic brain injuries (TBI) using different clinical assessment tools would facilitate diagnosis and effective inpatient follow-up. We aimed to describe rates of diagnosis, classification, documentation, and referral practices for TBI inpatients.

Material And Methods: In a retrospective cohort study, we reviewed electronic clinical records of adult patients admitted to a hospital ward with head trauma from an emergency department (ED) in 2021.

Insulin-like growth factor binding protein-3 (IGFBP-3): a biomarker of coronary artery disease induced myocardial ischaemia.

Aims: Among individuals presenting to the emergency department (ED) with chest pain, clinical uncertainty surrounds the appropriate identification of non-myocardial infarction (MI) individuals who would most benefit from objective functional/anatomical testing (e.g. imaging).

Effect of change of high-sensitivity troponin I assay on emergency department diagnosis and disposition of patients with possible acute coronary syndrome.

Objective: Changing cardiac troponin (cTn) assays may affect a hospital's admission and myocardial infarction rates. The effect of changing from a contemporary to high-sensitivity (hs) cTnI assay has been well described, but the real-life impact on disposition and diagnosis of changing from one hs-cTnI assay to another has not.

Methods: All patients who received a troponin measurement in the ED during 16 weeks were adjudicated to identify those the attending physician investigated for possible acute coronary syndrome (ACS) and for clinical outcomes.

A Common Algorithm for Cardiac Troponin to Rule Out and Rule in Acute Myocardial Infarction.

Background: A limitation of diagnostic algorithms in patients with suspected myocardial infarction (MI) is the requirement for assay-specific high-sensitivity cardiac troponin (hs-cTn) cutoff concentrations and change criteria. In this study we evaluated a common change criteria algorithm (3C) for hs-cTn and compared it with established algorithms for the rule out and rule in of MI.

Methods: We applied the 3C algorithm in 2 prospective cohort studies (with 3 different hs-cTn assays) of patients who presented to the emergency department with suspected MI who had serial hs-cTn results available.

Evidence-based medicine and the cardiac troponin 99th percentile for the diagnosis of acute myocardial infarction.

The 99th percentile of cardiac troponin assays for determining the presence of acute myocardial infarction (AMI) was set when assay analytical performance was much less precise than currently and was chosen, in part, to reduce the frequency of 'false-positive' results. A result greater than 99th percentile criterion has been a requirement of each version of the universal definition of MI. It also became used as a dichotomous decision-making threshold in diagnostic strategies for investigating AMI in acute care settings.

Clinical derivation and data simulated validation of rule-out and rule-in algorithms for the Siemens Atellica IM high-sensitivity cardiac troponin I assay.

Aims: This prospective, two-centre study derived and validated predictive algorithms for the Siemens Atellica IM high-sensitivity cardiac troponin I (hs-cTnI) assay in the emergency department (ED).

Methods And Results: Algorithms for predicting 30-day myocardial infarction (MI) Types 1 and 2 and death or non-ST-elevation MI (NSTEMI, Types 1 and 2) at index admission were developed from a derivation cohort of 1896 patients and validated using a synthetic data set with nearly 1 million patient cases. Performance was compared with the European Society of Cardiology algorithms for hs-cTnT (Roche Diagnostics) and hs-cTnI (Abbott Diagnostics).

Emergency department use of a high-sensitivity point-of-care troponin assay reduces length of stay: an implementation study preliminary report.

Aims: Point-of-care (POC) high-sensitivity troponin (hs-cTn) assays within a clinical pathway may safely reduce length of stay (LoS) for patients presenting to the emergency department (ED) with possible acute myocardial infarction (AMI). In this early report, we present the first evaluation of a POC hs-cTn in real-life care.

Methods And Results: In adult patients presenting to ED investigated for possible AMI, we compared the LoS in patients assessed with a troponin in the 8 weeks before (usual-care phase) and the 8 weeks following introduction of the Siemens Atellica VTLi POC hs-cTnI for decision-making (intervention phase).

Analytical verification of the Atellica VTLi point of care high sensitivity troponin I assay.

Objectives: The Siemens Point-of-Care Testing (POC) Atellica VTLi high-sensitivity troponin I (hsTnI) device has been previously validated. Verification independently provides evidence that an analytical procedure fulfils concordance with laboratory assays, imprecision, and hemolysis interference requirements.

Methods: Five whole blood samples spanning the measuring interval were analysed 20 times in succession.

Protocol for Improving Care by FAster risk-STratification through use of high sensitivity point-of-care troponin in patients presenting with possible acute coronary syndrome in the EmeRgency department (ICare-FASTER): a stepped-wedge cluster randomised quality improvement initiative.

Introduction: Clinical assessment in emergency departments (EDs) for possible acute myocardial infarction (AMI) requires at least one cardiac troponin (cTn) blood test. The turn-around time from blood draw to posting results in the clinical portal for central laboratory analysers is ~1-2 hours. New generation, high-sensitivity, point-of-care cardiac troponin I (POC-cTnI) assays use whole blood on a bedside (or near bedside) analyser that provides a rapid (8 min) result.

Determination of Clinically Acceptable Analytical Variation of Cardiac Troponin at Decision Thresholds.

Background: Clinical decision-making for risk stratification for possible myocardial infarction (MI) uses high-sensitivity cardiac troponin (hs-cTn) thresholds that range from the limit of detection to several-fold higher than the upper reference limit (URL). To establish a minimum analytical variation standard, we can quantify the effect of variation on the population clinical measures of safety (sensitivity) and effectiveness [proportion below threshold, or positive predictive value (PPV)].

Methods: From large datasets of patients investigated for possible MI with the Abbott hs-cTnI and Roche hs-cTnT assays, we synthesized datasets of 1 000 000 simulated patients.

Prognostic performance of soluble urokinase plasminogen activator receptor for heart failure or mortality in Western and Asian patients with acute breathlessness.

Aims: The performance of circulating soluble urokinase plasminogen activator receptor (suPAR) for predicting the composite endpoint of subsequent heart failure (HF) hospitalisation and/or death at 1 year was assessed in (i) patients with undifferentiated breathlessness, and generalisability was compared in (ii) disparate Western versus Asian sub-cohorts, and in (iii) the sub-cohort adjudicated with HF.

Methods And Results: Patients with acute breathlessness were recruited from the emergency departments in New Zealand (NZ, n = 612) and Singapore (n = 483). suPAR measured in the presentation samples was higher in patients incurring the endpoint (n = 281) compared with survivors (5.

Convalescent Growth Differentiation Factor-15 and Long-Term Outcomes after an Acute Coronary Syndrome.

Background: Growth differentiation factor-15 (GDF-15) has been shown to be associated with adverse clinical outcomes in patients after an acute coronary syndrome when measured soon after an event. Although dynamic in the acute phase after myocardial injury, GDF-15 has been shown to remain stable during convalescence. In this study, we aimed to assess the value of GDF-15 as a long-term prognostic marker for clinical outcomes when measured in the convalescent phase following an acute coronary syndrome.

Failure rates of nonoperative management of low-grade splenic injuries with active extravasation: an Eastern Association for the Surgery of Trauma multicenter study.

Objectives: There is little evidence guiding the management of grade I-II traumatic splenic injuries with contrast blush (CB). We aimed to analyze the failure rate of nonoperative management (NOM) of grade I-II splenic injuries with CB in hemodynamically stable patients.

Methods: A multicenter, retrospective cohort study examining all grade I-II splenic injuries with CB was performed at 21 institutions from January 1, 2014, to October 31, 2019.

Derivation and Validation of Thresholds Using Synthetic Data Methods for Single-Test Screening of Emergency Department Patients with Possible Acute Myocardial Infarction Using a Point-of-Care Troponin Assay.

Background: Single-sample (screening) rule-out of acute myocardial infarction (AMI) with troponin requires derivation of a single-test screening threshold. In data sets with small event numbers, the lowest one or two concentrations of myocardial infarction (MI) patients dictate the threshold. This is not optimal.