Potential impact of a point-of-care high-sensitivity cardiac troponin assay on emergency department length of stay and patient disposition

Sep 29, 2026

Uploaded by hdkawk

Evaluated whether point-of-care (POC) high-sensitivity cardiac troponin (hs-cTn) testing could reduce emergency department length of stay (LOS) and influence patient disposition. The study simulated potential LOS based on a fixed 20-minute POC turnaround time versus observed laboratory Access hsTnI turnaround. Outcomes compared median paired LOS differences and mean LOS reduction across admitted and discharged patients after single or serial hs-cTnI testing, while assessing how laboratory-versus-POC result discrepancies could affect decision-making.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages3

Reading Time8 min

AccessFree to download

Introduction

Study setting and participants

Inclusion and exclusion criteria

POC testing approach and outcomes

Primary outcome: turnaround time and LOS

Patient characteristics and results

Tables: patient characteristics and LOS components

Letter Potential impact of a point-ofcare high-sensitivity cardiac troponin assay on emergency department length of stay and patient disposition: findings from a cardiac emergency department The emergency department (ED) use of safe and time-efficient 0-1-hour assessment algorithms for suspected myocardial infarction (MI) is recommended.1 However, laboratory-based high-sensitivity cardiac troponin (hs-cTn) results are often not available within 1 hour from blood draw.2 Point-of-care (POC) hs-cTn assays, with shorter turnaround times (TATs), would solve this problem.2 One study has reported reduced ED length of stay (LOS) from POC-hs-cTnI use in routine clinical care.3 At the Victorian Heart Hospital ED (Monash Health, Australia), we evaluated one of the available POC-hs-cTnIassays, the TriageTrue analyser (QuidelOrtho Corporation, San Diego, California, USA), for which evidence of benefits in actual practice remains limited.4 5 We compared the potential LOS which could result from POC use with the actual LOS using our laboratory Access hsTnIassay.6 Characteristics of both assays are defined and publicly available.6 The study was approved by the institutional ethics committee as a quality assurance project not requiring patient consent. Patients having single and/or serial laboratory-hs-cTnI tests in the ED for suspected MI were recruited when the research clinician was present to run the POC tests (weekdays 11:00–20:00, June–November 2024). Patients with ST-elevation MI were excluded, as were those with single POC tests when serial laboratory tests were done. The study population was those recruited to a concurrent validation study of POC diagnostic accuracy for MI, for which about 1500 patients were required. From the bloods routinely collected by nurses, 0.2 mL was retained for POC testing, which was performed within 4 hours, as per the recommended sample stability time. POC results were not available to treating clinicians. For the primary outcome, the POC TAT was defined as a constant of 20 min (2 min processing plus 18 min assay time, which was the time observed during the study). It was assumed arrival-to-sample-collection and result-todeparture times would remain unchanged Figure 1 Patient flow. ED, emergency department; MI, myocardial infarction; POC, point-of-care; STEMI, ST-elevation MI. Table 1 Patient characteristics and outcomes | Total population N=1213 | | | --- | --- | | Age | 64 (50–76) | | Male sex | 655 (54 .0) | | Cardiac risk factors and/or comorbidities Hypertension
Hypercholesterolaemia
Diabetes mellitus
Obesity
Current smoker
Known coronary artery disease
Prior coronary artery stenting or bypass grafting Prior peripheral arterial vascular disease
Prior stroke
Family history of coronary artery disease Dialysis for chronic kidney failure | 586 (48.3) | | | 561 (46 .3) | | | 287 (23 . 7) | | | 111 (9 .2) | | | 113 (9 .3) | | | 372 (30 . 7) | | | 262 (21 .6) | | | 58 (4.8) | | | 53 (4 .4) | | | 89 (7.3) | | | 6 (0.5) | | Admitted | 306 (25.2) | | MI diagnosis | 44 (3.6) | | Inpatient MI or death (all cause) (n=306) | 10 (3.2) | | Post-discharge MI or death (all cause) to 30-days (n=1213) | 4 (0.3) | | All results are n (%) except age=median (IQR) .
MI, myocardial infarction. | | Emerg MedJ Month 2025 Vol 0 No 0 1 Table 2 Length of stay components in minutes for those admitted and discharged after having single baseline or serial troponin tests in the emergency department | Disposition and test | | Arrival to
baseline
sampling | Test turnaround time | Arrival to result available | Result available
to ED departure | Total ED LOS | Median of paired
LOS differences | Mean LOS reduction per patient | | --- | --- | --- | --- | --- | --- | --- | --- | --- | | Admitted after
single hs-cTnIN=153 | Laboratory testing | 38 (24–54) | 48 (39–57) | 88 (73–108) | 275 (127–504) | 360 (226–
603) | 28 (19–37) | 32 (27 to 38) | | | POC testing

FAQs

Why is point-of-care hs-cTn testing important in the emergency department?

Laboratory hs-cTn results often cannot be obtained within 1 hour, limiting use of rapid assessment algorithms. POC hs-cTn assays with shorter turnaround times could address this delay.

How was the primary length-of-stay comparison performed?

The study calculated potential LOS using a fixed 20-minute POC turnaround time and compared it with actual LOS using observed laboratory turnaround times. The comparison was made across four disposition and testing subgroups.

What kinds of patients were included or excluded?

Patients with suspected myocardial infarction who had single and/or serial ED laboratory hs-cTn testing were recruited when the research clinician was available to run POC tests. ST-elevation MI cases were excluded, and patients with single POC tests were excluded when serial laboratory tests were done.

Sep 29, 2026

Uploaded by hdkawk