Introduction of a high sensitivity troponin reduces ED length of stay

Background: High sensitivity cardiac troponins (hs-cTn) allow earlier identification and exclusion of acute myo-cardial infarction. We determined if transitioning from contemporary to high sensitivity troponin T (hs-cTnT) would reduce ED length of stay in chest pain (CP) patients.Methods: We conducted a pragmatic, prospective, before and after study of implementing a hs-cTnT by reviewing the electronic health records in all adult ED patients presenting to a large, suburban academic medical center dur-ing the 3 months before and after transitioning from a 4th generation troponin to a 5th generation hs-cTnT (Elecsys (R) Troponin T-high sensitive, Roche Diagnostics, Indianapolis, IN).Results: There were 1431 and 1437 CP patients before and after the intervention. Mean (SD) age was 51.5 (18) yrs. and 54.3% were female. The median (IQR) ED LOS for chest pain patients directly discharged to home was 6.2 (4.7-8.4) and 5.3 (4.0-7.2) hours before and after introducing hs-cTn respectively; difference 47 min (95% CI, 35-59); P < 0.001. The median (IQR) ED LOS for chest pain patients admitted to the hospital was 9.5 (6.6-13.8) and 8.1 (5.7-11.2) hours before and after introducing hs-cTn respectively; difference 77 min (95% CI, 35-121); P < 0.001. Overall admission rates (22 vs 21% both before and after) did not change during the study. The rates of computed tomography coronary angiography before and after the intervention were 21 and 20.4% respectively. The rates of invasive coronary angiography before and after the intervention were 5.8 and 5.6% respectively.Conclusions: Transitioning to a hs-cTnT is associated with a clinically relevant and statistically significant reduction in ED LOS for both discharged and admitted patients with and without CP with no increase in admission or coronary angiography rates.(c) 2023 Elsevier Inc. All rights reserved.

Automated summary

The study findings suggest that transitioning to high sensitivity troponin T (hs-cTnT) is significantly associated with reducing the emergency department length of stay for chest pain patients, without an increase in admission or coronary angiography rates.