Troponin Point-of-Care Testing
The Research Question
"What do the scientific literature and local knowledge tell us about the clinical effectiveness, feasibility and acceptability of [troponin] point of care testing for emergency departments of smaller hospitals and health centres in Newfoundland and Labrador?"
Health system administrators in NL prioritize equitable access to health services but are challenged to maintain around-the-clock labs for all emergency departments in the province. Delays in medical testing and patient management decisions based on incomplete information are problematic for clinicians and potentially dangerous for patients. In an effort to look into this issue, the Point-of-Care Testing (POCT) CHRSP project was initiated through a topic submission from Eastern Health to study the effectiveness, feasibility and acceptability of point-of-care testing in emergency departments, particularly those in smaller hospitals without 24/7 central laboratories. After reviewing the range of potential point-of-care tests and consulting with our team leader and local experts, the CHRSP Project Team decided to focus on troponin point-of-care testing for suspected Acute Coronary Syndrome of patients presenting to the emergency rooms of smaller health centres and hospitals in Newfoundland and Labrador.
Results in Brief
- Point-of-care testing is a quickly-developing technology. Cardiac troponin POCT has rapidly improved detection threshold sensitivity and accuracy in recent years. One independent study has demonstrated that, as a screening test, cardiac troponin POCT is comparable to, and as reliable as, central lab testing. A new class of ‘high-sensitivity’ troponin POCT has been shown to be even more sensitive and more accurate.
- Compared to central lab testing, patients screened with cardiac troponin POCT have similar rates of adverse events and faster test turnaround times, but do not necessarily improve on any other emergency department (ED) process outcome variables such as time to clinical decision making or time to discharge.
- Cardiac troponin testing methods are not the determining factor for ED process outcomes. Instead, site-specific variables such as the organization of the facilities themselves, local protocols, existing and implemented guidelines for related conditions and symptoms, existing POCT programs and staffing variables, appear to be the major contributors to the variability of evidence for ED process outcomes.
- At present, cardiac troponin POCT is more expensive than central lab testing in an overall context, in terms of individual test costs, quality control, implementation and training. However, some economic benefits have been reported in the review literature, particularly those accruing from a decreased test turnaround time and improved throughput of patients in the ED.
The CHRSP Project Team:
- Dr. Nitika Pant Pai (Team Leader), Assistant Professor Department of Medicine McGill, Division of Clinical Epidemiology; Researcher, McGill University Health Centre; Infectious Diseases and Immunodeficiency Service Researcher, Montreal Chest Institute
- Dr. Michel Grignon (Health Economist), Director, Centre for Health Economics and Policy Analysis, McMaster University
- Vickie Kaminski (Health System Partner), CEO, Eastern Health (St. John's)
- Dr. Stephen Bornstein (CHRSP Program Director), Director, NLCAHR & Professor, Political Science, Memorial University
- Dr. Beverley Carter, Provincial Director of Pathology and Laboratory Medicine, Department of Health and Community Services (St. John's)
- Gail Downing, Regional Director for Emergency and Paramedicine, Eastern Health (Carbonear)
- Dr. Michael Jong, VP Medical Affairs, Labrador Grenfell Health (Happy Valley-Goose Bay)
- Sarah Mackey, Research Assistant II, Newfoundland & Labrador Centre for Applied Health Research
- Pablo Navarro (Project Coordinator), Senior Research Officer, Newfoundland & Labrador Centre for Applied Health Research
- Dr. Dennis Rashleigh, District Medical Officer, Western Health (Corner Brook)
- Dr. Stephanie Squibb, Senior Medical Officer, Dr. William H. Newhook Community Health Centre (Whitbourne)
- Janet Templeton, Regional Program Director, Medicine and Ambulatory Care, Eastern Health (St. John's)
- Lynn Wade, Director, Laboratory Medicine, Eastern Health (St. John's)