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The following is a summary of “Introduction of a high sensitivity troponin reduces ED length of stay,” published in the February 2024 issue of Emergency Medicine by Singer, et al.

The introduction of high-sensitivity cardiac troponins (hs-cTn) has revolutionized the early detection and exclusion of acute myocardial infarction. For a study, researchers sought to investigate whether transitioning from contemporary to high-sensitivity troponin T (hs-cTnT) would lead to a reduction in emergency department (ED) length of stay (LOS) among chest pain (CP) patients.

They conducted a pragmatic, prospective, before-and-after study by reviewing electronic health records of all adult ED patients presenting to a large suburban academic medical center. The study spanned 3 months before and after transitioning from a 4th generation troponin to a 5th generation hs-cTnT (Elecsys® Troponin T-high sensitive, Roche Diagnostics, Indianapolis, IN).

A total of 1,431 and 1,437 CP patients were included before and after the intervention, with a mean (SD) age of 51.5 (18) years and 54.3% female. The median (IQR) ED LOS for CP patients discharged directly home decreased from 6.2 (4.7–8.4) hours to 5.3 (4.0–7.2) hours post-intervention, a difference of 47 minutes (95% CI, 35–59; P < 0.001). For CP patients admitted to the hospital, the median (IQR) ED LOS decreased from 9.5 (6.6–13.8) hours to 8.1 (5.7–11.2) hours, a difference of 77 minutes (95% CI, 35–121; P < 0.001). Overall admission rates remained unchanged at 22% before and after the intervention. Rates of computed tomography coronary angiography and invasive coronary angiography also remained stable at 21% and 5.8% before the intervention and 20.4% and 5.6% after the intervention, respectively.

Transitioning to hs-cTnT is associated with a clinically relevant and statistically significant reduction in ED LOS for both discharged and admitted CP patients, without an increase in admission or coronary angiography rates.

Reference: sciencedirect.com/science/article/abs/pii/S0735675723006411