Diagnostic, clinical and laboratory turnaround times in troponin T testing
Mari Ervasti1, Karri Penttilä, Sirkku Siltari
1Department of Clinical Chemistry, Kuopio University, Eastern Finland Laboratory Center, Kuopio, Finland. mari.ervasti@uku.fi
Insights
The median diagnostic turnaround time (TAT) for troponin T testing in emergency departments was 122 minutes, significantly longer than the recommended 1 hour. This study highlights delays in the overall diagnostic process, not just laboratory analysis, for myocardial infarction diagnosis.
Area of Science:
- Clinical Chemistry
- Emergency Medicine
- Cardiology
Background:
- Troponin measurements are crucial for diagnosing myocardial infarction.
- A consensus exists for a turnaround time (TAT) of 1 hour or less for cardiac marker assays.
- Real-world delays between patient arrival in the emergency department (ED) and test reporting are not well understood.
Purpose of the Study:
- To analyze the turnaround times (TATs) for troponin T (TnT) testing in a hospital emergency department setting.
- To identify specific delays within the diagnostic process from patient arrival to test result reporting.
Main Methods:
- Analyzed TATs for troponin T (TnT) in 215 patients admitted to the Kuopio University Hospital ED.
- Recorded four key time points: patient arrival, test order, blood sample arrival at the lab, and test completion/reporting.
- Differentiated between clinical TAT, laboratory TAT, and analytical TAT.
Main Results:
- The median diagnostic TAT from patient arrival to TnT result reporting was 122 minutes.
- Clinical TAT averaged 46 minutes, while laboratory TAT averaged 69 minutes.
- Laboratory TAT comprised preanalytical ED time (14 min), laboratory pre/postanalytical time (40 min), and analytical time (10 min).
Conclusions:
- Proposed new concepts for diagnostic TAT, encompassing both clinical and laboratory components.
- Emphasized the need to shift focus from analytical TAT to the entire diagnostic process for myocardial infarction.
- The laboratory TAT constituted approximately half of the total diagnostic TAT.
Background:
At present, measurements of troponins play a key role in the diagnosis of myocardial infarction. There is a consensus that a turnaround time (TAT) of 1 h or less should be achieved for cardiac marker assays. However, little is known about the real delays between the patient's arrival at the emergency department (ED) and the reporting of the test.
Methods:
In the present study, the TATs of a cardiac marker, troponin T (TnT), were analyzed at a central laboratory at Kuopio University Hospital in a population consisting of 215 patients who were admitted to the hospital ED. Four specific time points were recorded: 1) the time of the patient's arrival to the ED, 2) the time of the ordering of the test, 3) the time when blood samples arrived at the laboratory, and 4) the time of completion and reporting of the test.
Results:
The median diagnostic TAT from patient's arrival to the reporting of the TnT result was 122 min. The clinical median TAT was 46 min and the laboratory median TAT was 69 min. Laboratory TAT consisted of the preanalytical TAT at the ED (median 14 min), pre- and postanalytical TAT in the laboratory (median 40 min), and the analytical TAT (on average 10 min). The laboratory TAT was approximately half of the complete diagnostic TAT.
Conclusions:
On the basis of this analysis, we propose new concepts for the TATs in the diagnostic process: diagnostic TAT which consists of clinical and laboratory TAT. The focus should be shifted from the analytical TAT to the diagnostic process as a whole.
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