背景:在急诊医学中评估高敏肌钙蛋白I水平对于诊断急性心肌梗死(AMI)至关重要。本研究旨在评估三级护理中心急诊科的中心实验室与床旁肌钙蛋白I测试。
方法:这项前瞻性观察性研究是在D.Y.Patil医学院进行的,医院和研究中心,浦那,马哈拉施特拉邦,印度,2023年10月至12月。在中央实验室使用DimensionEXL200(Siemens®HealthcareDiagnosticsInc.,Erlangen,德国)作为黄金标准测试,并通过使用TriageTrue®(QuidelCorporation,圣地亚哥,CA)高灵敏度肌钙蛋白I试剂盒,在Triage®MeterPro®设备上运行(QuidelCorporation,圣地亚哥,CA).该装置定量测定乙二胺四乙酸抗凝全血和血浆标本中的肌钙蛋白I。对结果进行了比较。使用SPSS第18版(SPSSInc.,芝加哥,IL).进行非配对t检验以比较使用两种测试方法所花费的时间的差异。
结果:床旁测试获得肌钙蛋白I结果的平均时间明显较短(14.91分钟,标准偏差(SD)=0.5)比实验室测试(119.1分钟,SD=5.03)。统计分析显示显著差异(t=-172.36,p<0.001)。进行了卡方检验,以评估两种测试方法之间的差异,得到的卡方值为32.64,p值为0.00001,表明床边测试和实验室测试之间存在显着差异。
结论:在印度的急诊医学部门中,床旁高敏肌钙蛋白I测试比实验室测试具有相当大的优势。这种快速诊断能力对于及时管理至关重要,这对于不确定急性冠脉综合征样非ST段抬高型心肌梗死(NSTEMI)的患者是有益的。它也具有成本效益。它还减少了紧急登机时间,并可能减少医疗设施中不必要的入院人数。
BACKGROUND: Evaluating high-sensitivity troponin I levels in emergency medicine is critical for diagnosing acute myocardial infarction (AMI). This study aims to evaluate the central laboratory versus bedside troponin I test in the emergency department of a tertiary care center.
METHODS: This prospective observational study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, from October to December 2023. Patient samples were analyzed in the central laboratory using the Dimension EXL 200 (Siemens® Healthcare Diagnostics Inc., Erlangen, Germany) as the gold standard test and through point-of-care testing using the TriageTrue® (Quidel Corporation, San Diego, CA) high-sensitivity troponin I kit, which was run on the Triage® MeterPro® device (Quidel Corporation, San Diego, CA). This device quantitatively determines troponin I in ethylenediaminetetraacetic acid-anticoagulated whole blood and plasma specimens. The results were compared. Statistical analysis was performed using SPSS version 18 (SPSS Inc., Chicago, IL). An unpaired t-test was performed to compare the difference in time taken using the two testing methods.
RESULTS: The mean time for obtaining troponin I results was substantially shorter with bedside testing (14.91 minutes, standard deviation (SD) = 0.5) than with laboratory testing (119.1 minutes, SD = 5.03). Statistical analysis revealed a significant difference (t = -172.36, p < 0.001). A chi-square test was conducted to assess the disparity between the two testing methods, yielding a chi-square value of 32.64 and a p value of 0.00001, indicating a significant difference between bedside testing and laboratory testing.
CONCLUSIONS: The bedside high-sensitivity troponin I test offers a considerable advantage over laboratory testing regarding turnaround time within the emergency medicine department in India. This rapid diagnostic capability is crucial for timely management, which is beneficial for patients inconclusive of acute coronary syndrome-like non-ST segment elevation myocardial infarction (NSTEMI). It is also cost-effective. It also reduces the emergency boarding time and may reduce the number of unnecessary admissions in healthcare facilities.