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Whole Blood Cardiac Troponin "Triaging" to Improve Early Detection of Myocardial Injury at a Pediatric Hospital
Lawrence de Koning1,2,3, Isolde Seiden-Long1,3, Katherine Anker4,5
1Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, Canada.
Insights
Implementing on-site cardiac troponin (cTn) testing in pediatric hospitals significantly reduces turnaround times for myocardial injury diagnosis. This rapid point-of-care whole blood cTnI testing offers a viable interim solution for hospitals awaiting off-site high-sensitivity troponin results.
Area of Science:
- Pediatric Cardiology
- Clinical Diagnostics
- Point-of-Care Testing
Background:
- Delays in off-site high-sensitivity cardiac troponin T (hs-cTnT) testing impact timely diagnosis of myocardial injury in pediatric hospitals.
- The importance of on-site cardiac troponin (cTn) testing at pediatric facilities may be underestimated.
Purpose of the Study:
- To develop and evaluate a rapid rule-in process for myocardial injury using on-site testing at a pediatric hospital.
- To improve turnaround times (TATs) for cardiac troponin testing.
Main Methods:
- Reviewed collect-to-verify TATs for off-site hs-cTnT testing.
- Implemented and evaluated pre-analytic changes to improve TATs.
- Selected and evaluated a new analyzer for on-site cTn testing using whole blood cardiac troponin I (cTnI) assay.
Main Results:
- Off-site STAT hs-cTnT testing had a median TAT of 104 minutes, with 35% exceeding 120 minutes.
- On-site cTnI testing achieved median TATs less than 50% of off-site hs-cTnT testing.
- Elevated cTnI showed 91% sensitivity for significant hs-cTnT elevations but 0% for modest elevations, prompting interpretive comments.
Conclusions:
- On-site point-of-care whole blood cTn testing can rapidly confirm significant myocardial injury.
- This workflow serves as a viable interim solution for pediatric hospitals lacking on-site hs-cTn testing, when combined with off-site testing.
Background:
The importance of offering on-site cardiac troponin (cTn) testing at pediatric hospitals may be underappreciated. We developed a rapid rule-in process for myocardial injury at a pediatric hospital experiencing delays in off-site high-sensitivity cardiac troponin T (hs-cTnT) testing.
Methods:
Collect-to-verify turnaround times (TATs) for off-site testing were reviewed. Pre-analytic changes to improve TATs were devised, implemented and evaluated, after which a new analyzer was selected and evaluated for on-site cTn testing. Performance of the new analyzer's assay was compared to the off-site hs-cTnT assay, and post go-live TATs for on-site testing were assessed.
Results:
Median collect-to-verify TAT for short turnaround-time (STAT) priority off-site plasma hs-cTnT testing was 104 min, with 35% of orders having a TAT >120 min. Eliminating serum separator tubes and requiring a separate plasma separator tube did not significantly reduce TATs. A QuidelOrtho Triage® MeterPro whole blood cardiac troponin I (cTnI) assay was implemented to "triage" time-critical and STAT priority specimens collected for off-site hs-cTnT testing. Elevated cTnI (≥0.02 µg/L) had a sensitivity of 91% for clear elevations in hs-cTnT (≥53 ng/L) but a 0% sensitivity for modest elevations (5 to 13 ng/L, 14 to 52 ng/L). An interpretive comment was auto-appended to cTnI results indicating that clinicians should wait for the hs-cTnT result if cTnI was normal. Median collect-to-verify TAT for on-site cTnI testing was <50% the TAT for off-site hs-cTnT testing.
Conclusions:
On-site point-of-care whole blood cTn testing can rapidly confirm significant or late-presenting myocardial injury. Combined with simultaneous off-site high-sensitivity cardiac troponin (hs-cTn) testing, this workflow is a viable interim solution for pediatric hospitals without on-site hs-cTn testing.
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