Evidence map›Paper›PMID 25661303›Full record

SynthesisClinical biochemistry2015

Effectiveness of practices for improving the diagnostic accuracy of Non ST Elevation Myocardial Infarction in the Emergency Department: A Laboratory Medicine Best Practices™ systematic review.

Christopher Layfield, John Rose, Aaron Alford, Susan R Snyder, Fred S Apple, Farah M Chowdhury, Michael C Kontos, L Kristin Newby, Alan B Storrow, Milenko Tanasijevic and 3 more

Open access · greenAbstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Clinical biochemistry, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
3.0field-weighted citation impact, top 8% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Review
  4. Article
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 9 institutions in 1 country.

Christopher LayfieldBattelle Memorial Institute, USA. Electronic address: layfieldc@battelle.org.
John RoseBattelle Memorial Institute, USA.
Aaron AlfordBattelle Memorial Institute, USA.
Susan R SnyderGeisinger Center for Health Research, USA.
Fred S AppleHennepin County Medical Center, USA; University of Minnesota Medical School, USA.
Farah M ChowdhuryCenters for Disease Control and Prevention (CDC), Atlanta, GA, USA.
Michael C KontosVirginia Commonwealth University Medical Center, USA.
L Kristin NewbyDuke University Medical Center, USA.
Alan B StorrowVanderbilt University Medical Center, USA.
Milenko TanasijevicBrigham and Women's Hospital, USA; Harvard Medical School, USA.
Elizabeth LeibachCenters for Disease Control and Prevention (CDC), Atlanta, GA, USA.
Edward B LiebowAmerican Anthropological Association, USA.
Robert H ChristensonUniversity of Maryland School of Medicine, USA.
Battelle · USCenters for Disease Control and Prevention · USAmerican Anthropological Association · USBrigham and Women's Hospital · USDuke Medical Center · USUniversity of Maryland, Baltimore · USUniversity of Minnesota Medical Center · USVanderbilt University Medical Center · USVirginia Commonwealth University Medical Center · US

Funding

Intramural CDC HHS CC999999
6 · The paper itself

Abstract

objectivesThis article is a systematic review of the effectiveness of four practices (assay selection, decision point cardiac troponin (cTn) threshold selection, serial testing, and point of care testing) for improving the diagnostic accuracy Non-ST-Segment Elevation Myocardial Infarction (NSTEMI) in the Emergency Department. DESIGN AND

methodsThe CDC-funded Laboratory Medicine Best Practices (LMBP) Initiative systematic review method for quality improvement practices was used.

resultsThe current ACC/AHA guidelines recommend using cardiac troponin assays with a 99th percentile upper reference limit (URL) diagnostic threshold to diagnose NSTEMI. The evidence in this systematic review indicates that contemporary sensitive cTn assays meet the assay profile requirements (sensitivity, specificity, PPV, and NPV) to more accurately diagnose NSTEMI than alternate tests. Additional biomarkers did not increase diagnostic effectiveness of cTn assays. Sensitivity, specificity, and NPV were consistently high and low PPV improved with serial sampling. Evidence for use of point of care cTn testing was insufficient to make recommendation, though some evidence suggests that use may result in reduction to patient length of stay and costs.

conclusionsBased on the review of and the LMBP(TM) A-6 Method criteria, we recommend the use of cardiac troponin assays without additional biomarkers using the 99th percentile URL as the clinical diagnostic threshold for the diagnosis of NSTEMI. We recommend serial sampling with one sample at presentation and at least one additional second sample taken at least 6h later to identify a rise or fall in the troponin level. No recommendation is made either for or against the use of point of care tests. DISCLAIMER: The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention/the Agency for Toxic Substances and Disease Registry (CDC/ATSDR).

Indexed as

BiomarkersEmergency Service, HospitalHumansMyocardial InfarctionPractice Guidelines as TopicTroponinTroponin ITroponin TBiomarkersTroponinTroponin ITroponin TAcute coronary syndromeCardiac troponinMyocardial infarctionNon-ST-segment elevation

Identifiers

PMID25661303
PMCPMC5033652
OpenAlexW2044002087

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.