Annals of Emergency Medicine
Volume 53, Issue 3 , Pages 321-328 , March 2009

A Multicenter Randomized Controlled Trial Comparing Central Laboratory and Point-of-Care Cardiac Marker Testing Strategies: The Disposition Impacted by Serial Point of Care Markers in Acute Coronary Syndromes (DISPO-ACS) Trial

Presented as an abstract at the Society for Academic Emergency Medicine annual meeting, May 2007, Chicago, IL.

  • Richard J. Ryan, MD

      Affiliations

    • Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH
    • Corresponding Author InformationAddress for correspondence: Richard J. Ryan, MD, Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH 45267; 513-558-8104, fax 513-558-5791
    • ,
  • Christopher J. Lindsell, PhD

      Affiliations

    • Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH
    • ,
  • Judd E. Hollander, MD

      Affiliations

    • Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA
    • ,
  • Brian O'Neil, MD

      Affiliations

    • Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI
    • ,
  • Raymond Jackson, MD

      Affiliations

    • Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, MI
    • ,
  • Donald Schreiber, MD

      Affiliations

    • Division of Emergency Medicine, Stanford University, Stanford, CA
    • ,
  • Robert Christenson, PhD

      Affiliations

    • Department of Pathology, University of Maryland, Baltimore, MD
    • ,
  • W. Brian Gibler, MD

      Affiliations

    • Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH

Received 26 February 2008 ,Revised 29 May 2008 ,Accepted 24 June 2008.

References 

  1. Wilper AP, Woolhandler S, Lasser KE, et al. Waits to see an emergency department physician: US trends and predictors, 1997-2004. Health Aff (Millwood). 2008;27:w84–w95
  2. Magid DJ, Rhodes KV, Asplin BR, et al. Designing a research agenda to improve the quality of emergency care. Acad Emerg Med. 2002;9:1124–1130
  3. Lindsell CJ, Anantharaman V, Diercks D, et al. The Internet Tracking Registry of Acute Coronary Syndromes (i*trACS): a multicenter registry of patients with suspicion of acute coronary syndromes reported using the standardized reporting guidelines for emergency department chest pain studies. Ann Emerg Med. 2006;48:666–677
  4. Gibler WB, Runyon JP, Levy RC, et al. A rapid diagnostic and treatment unit for evaluating patients presenting to the emergency department with chest pain. Ann Emerg Med. 1995;25:1–8
  5. Gomez MA, Anderson JL, Karagounis LA, et al. An emergency department-based protocol for rapidly ruling out myocardial ischemia reduces hospital time and expense: results of a randomized study (ROMIO). J Am Coll Cardiol. 1996;28:25–33
  6. Graff LG, Dallara J, Ross MA, et al. Impact on the care of the emergency department chest pain patient from the Chest Pain Evaluation Registry (CHEPER) Study. Am J Cardiol. 1997;80:563–568
  7. Apple FS, Chung AY, Kogut ME, et al. Decreased patient charges following implementation of point-of-care cardiac troponin monitoring in acute coronary syndrome patients in a community hospital cardiology unit. Clin Chim Acta. 2006;370:191–195
  8. Lee-Lewandrowski E, Corboy D, Lewandrowski K, et al. Implementation of a point-of-care satellite laboratory in the emergency department of an academic medical center (Impact on test turnaround time and patient emergency department length of stay). Arch Pathol Lab Med. 2003;127:456–460
  9. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction—executive summary; a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of patients with acute myocardial infarction). J Am Coll Cardiol. 2004;44:671–719
  10. Braunwald E, Antman EM, Beasley JW, et al. ACC/AHA 2002 guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction—summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol. 2002;40:1366–1374
  11. Christenson RH, Apple FS, Cannon CP, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines for Utilization of Biochemical Markers in Acute Coronary Syndromes and Heart Failure. http://www.aacc.org/sitecollectiondocuments/nacb/impg/acute_heart/NACBACS.pdfAccessed July 11, 2008
  12. Parvin CA, Lo SF, Deuser SM, et al. Impact of point-of-care testing on patients' length of stay in a large emergency department. Clin Chem. 1996;42:711–717
  13. Singer AJ, Viccellio P, Thode HC, et al. Introduction of a stat laboratory reduces emergency department length of stay. Acad Emerg Med. 2008;15:324–328
  14. Wichmann BA, Hill ID. Algorithm AS 183 (An efficient and portable pseudo-random number generator). Applied Stat. 1982;31:188–190
  15. Hollander JE, Blomkalns AL, Brogan GX, et al. Multidisciplinary Standardized Reporting Criteria Task Force Standardized Reporting Criteria Working Group of Emergency Medicine Cardiac Research and Education Group-International Standardized reporting guidelines for studies evaluating risk stratification of emergency department patients with potential acute coronary syndromes. Ann Emerg Med. 2004;44:589–598
  16. Storrow AB, Lindsell CJ, Collins SP, et al. Emergency department multimarker point-of-care testing reduces time to cardiac marker results without loss of diagnostic accuracy. Point Care. 2006;5:132–136
  17. Bonett DG, Price RM. Statistical inference for a linear function of medians: confidence intervals, hypothesis testing and sample size requirements. Psychol Methods. 2002;3:370–383
  18. Newby LK, Christenson RH, Ohman EM, et al. Value of serial troponin T measures for early and late risk stratification in patients with acute coronary syndromes (The GUSTO-IIa Investigators). Circulation. 1998;98:1853–1859

 Supervising editor: Donald M. Yealy, MD

 Dr. Yealy was the supervising editor on this article. Dr. Hollander did not participate in the editorial review or decision to publish this article.

 Author contributions: All authors contributed to the conception and design of this study. WBG was responsible for obtaining funding. Data were collected by RJR, JEH, BO, RJ, and DS. CJL was responsible for data management and analysis. All authors were involved in the interpretation of the data. RJR and CJL drafted the article, and all authors provided critical feedback. RJR takes responsibility for the paper as whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article, that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. This study was funded in part by i-STAT/Abbott POC. The funding agency had no control over the study design, data collection, data analysis or interpretation and presentation of results. CJL and RJR have received research grants from Abbott POC.

 Publication dates: Available online August 8, 2008.

 Reprints not available from the authors.

PII: S0196-0644(08)01457-1

doi: 10.1016/j.annemergmed.2008.06.464

Annals of Emergency Medicine
Volume 53, Issue 3 , Pages 321-328 , March 2009

Article Tools

* Image Usage & Resolution