Evidence map›Paper›PMID 35428610›Full record

Observational studyBMJ open2022

Implementation and evaluation of a rural general practice assessment pathway for possible cardiac chest pain using point-of-care troponin testing: a pilot study.

Tim Norman, Joanna Young, Jo Scott Jones, Gishani Egan, John Pickering, Stephen Du Toit, Fraser Hamilton, Rory Miller, Chris Frampton, Gerard Devlin and 2 more

Open access · goldAbstract readObservational Study
In one paragraph

Observational study in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
2.3field-weighted citation impact, top 11% 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, 14 citations in OpenAlex.

  1. Review
  2. Review
  3. How Close Are We to Patient-Side Troponin Testing?Journal of clinical medicine · 2024
    Review
  4. Review
  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

12 authors at 5 institutions in 1 country.

Tim Norman *Project Office, Pinnacle Midlands Health Network, Hamilton, New Zealand.
Joanna Young *Department of Cardiology, Canterbury District Health Board, Christchurch, New Zealand.ORCID 0000-0003-0996-735X
Jo Scott JonesProject Office, Pinnacle Midlands Health Network, Hamilton, New Zealand.
Gishani EganProject Office, Pinnacle Midlands Health Network, Hamilton, New Zealand.
John PickeringEmergency Department, Canterbury District Health Board, Christchurch, New Zealand.ORCID 0000-0001-9475-0344
Stephen Du ToitDepartment of Clinical Chemistry, Waikato District Health Board, Hamilton, New Zealand.
Fraser HamiltonProject Office, Pinnacle Midlands Health Network, Hamilton, New Zealand.
Rory MillerProject Office, Pinnacle Midlands Health Network, Hamilton, New Zealand.
Chris FramptonChristchurch School of Medicine and Health Sciences, University of Otago Christchurch, Christchurch, New Zealand.
Gerard DevlinHeart Foundation of New Zealand, Auckland, New Zealand.
Peter GeorgeMedLab Pathology, Sydney, New South Wales, Australia.
Martin ThanEmergency Department, Canterbury District Health Board, Christchurch, New Zealand martin@thanstedman.onmicrosoft.com.ORCID 0000-0001-9399-5227
Canterbury District Health Board · NZUniversity of Otago · NZWaikato District Health Board · NZNational Heart Foundation of New Zealand · NZUniversity of Waikato · NZ

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo assess the feasibility and acceptability, and additionally to preliminarily evaluate, the effectiveness and safety of an accelerated diagnostic chest pain pathway in rural general practice using point-of-care troponin to identify patients at low risk of acute myocardial infarction, avoiding unnecessary patient transfer to hospital and enabling early discharge home.

designA prospective observational pilot evaluation.

settingTwelve rural general (family) practices in the Midlands region of New Zealand.

participantsPatients aged ≥18 years who presented acutely to rural general practice with suspected ischaemic chest pain for whom the doctor intended transfer to hospital for serial troponin measurement. OUTCOME MEASURES: The proportion of patients managed using the low-risk pathway without transfer to hospital and without 30-day major adverse cardiac event (MACE); pathway adherence; rate of 30-day MACE; patient satisfaction with care; and agreement between point-of-care and laboratory measured troponin concentrations.

resultsA total of 180 patients were assessed by the pathway. The pathway classified 111 patients (61.7%) as low-risk and all were managed in rural general practice with no 30-day MACE (0%, 95% CI 0.0% to 3.3%). Adherence to the low-risk pathway was 95.5% (106 out of 111). Of the 56 patients classified as non-low-risk and referred to hospital, 9 (16.1%) had a 30-day MACE. A further 13 non-low-risk patients were not transferred to hospital, with no events. The sensitivity of the pathway for 30-day MACE was 100.0% (95% CI 70.1% to 100%). Of low-risk patients, 94% reported good to excellent satisfaction with care. Good concordance was observed between point-of-care and duplicate laboratory measured troponin concentrations.

conclusionsThe use of an accelerated diagnostic chest pain pathway incorporating point-of-care troponin in a rural general practice setting was feasible and acceptable, with preliminary results suggesting that it may safely and effectively reduce the urgent transfer of low-risk patients to hospital.

Indexed as

General PracticeTroponinAdolescentAdultAngina PectorisBiomarkersChest PainElectrocardiographyEmergency Service, HospitalHumansPilot ProjectsPoint-of-Care SystemsProspective StudiesRisk AssessmentBiomarkersTroponincoronary heart diseasemyocardial infarctionprimary careprotocols & guidelines

Identifiers

PMID35428610
PMCPMC9013998
OpenAlexW4223956930

What OpenQuestion holds

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LicenceCC BY-NC
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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.