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Can point-of-care high sensitivity troponin improve efficiency: a multisite US study
Simon A Mahler1, Nicklaus P Ashburn2, Akalya Villenthi3
1Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA; Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
Background:
New point-of-care (POC) high sensitivity troponin (hs-cTn) assays could improve chest pain care efficiency. This study seeks to determine whether implementation of POC hs-cTn reduces key Emergency Department (ED) time metrics.
Methods:
A prospective cohort study was conducted at three U.S. EDs (February-September 2025). Adults without STEMI and at least one hs-cTnI ordered were accrued. Blood samples were collected simultaneously for POC hs-cTnI measurement on an i-STAT 1 analyzer (Abbott Laboratories) and central laboratory hs-cTnI measurement (Beckman Coulter). Following POC hs-cTn measures, providers were surveyed regarding potential disposition and treatment decisions which were compared to actual disposition times. Turnaround time, time-to-disposition, and ED length of stay for POC versus central laboratory measures were compared using Wilcoxon signed-rank tests.
Results:
During the study period, 602 patients were accrued, of which 48% (286/602) were female and median age was 60 years (IQR: 50-70). POC hs-cTnI had a median turnaround time of 16 min (IQR: 15-17) compared to 52 min (IQR: 45-61) for the central laboratory, a 36-min difference (p < 0.001). Median time to potential disposition decision using POC was 222 min (IQR: 144-320) versus 273 min (IQR: 219-382) for central laboratory measures, a difference of 51 min (p < 0.001). The median potential ED length of stay was 325 min (IQR: 224-513) for POC versus 387 min (IQR: 276-564) for the central laboratory, yielding a potential reduction of 62 min (p < 0.001).
Conclusions:
POC hs-cTnI measurement reduced turnaround time and produced substantive potential reductions in time-to-disposition decision and ED length of stay.
Trial Registration:
NCT06899776.
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