Trial is error? Evaluating the effectiveness of single-troponin diagnostic pathways.

The most tangible benefit of implementing high-sensitivity cardiac troponin (hs-cTn) assays is the potential to reduce length of stay for patients presenting to the hospital with symptoms compatible with acute myocardial infarction (AMI). There is now abundant evidence to demonstrate the high diagnostic accuracy of rapid diagnostic algorithms that aim to identify patients who have a very low probability of AMI within just a few hours of arriving in the emergency department (ED). By using very low cut-offs set at or close to the limit of detection (LoD) of hs-cTn assays, a single blood test is sufficient to ‘rule out’ the diagnosis of AMI for many patients.1 2 Those patients do not require any further inpatient investigation and may be suitable for immediate discharge, allowing the patients to benefit from earlier reassurance and relieving ED crowding. The ‘single-test’ strategy has substantial potential benefit for busy EDs. Avoiding a second venepuncture saves staff time. Further, more patients will have all the necessary investigation results to hand at the time of their consultation with a clinician. If clinicians do not have that information to hand, they are more likely to see new patients and are less likely to …