Evidence map›Paper›PMID 37993739›Full record

ArticleJournal of general internal medicine2024

Improved Utilization of Serial Testing Without Increased Admissions after Implementation of High-Sensitivity Troponin I: a Controlled Retrospective Cohort Study.

Laura Warren, Brett G Fischer, Amos Shemesh, Jean Scofi, Nekee Pandya, Robert J Kim, Caroline Andy, Sophie Rand, Jim Yee, Stacia Semple and 4 more

Abstract readMulticenter Study
In one paragraph

Article in Journal of general internal medicine, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
–field-weighted citation impact
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

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
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

14 authors.

Laura WarrenDepartment of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.
Brett G FischerWeill Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
Amos ShemeshDepartment of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA.
Jean ScofiDepartment of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA.
Nekee PandyaWeill Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
Robert J KimWeill Department of Medicine, Weill Cornell Medicine, New York, NY, USA.
Caroline AndyDivision of Biostatistics, Weill Cornell Medicine, New York, NY, USA.
Sophie RandDepartment of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.
Jim YeeDepartment of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.
Stacia SempleDepartment of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.
Amy ChadburnDepartment of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA.
He S YangDepartment of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA. hey9012@med.cornell.edu.
Peter A D SteelDepartment of Emergency Medicine, Weill Cornell Medicine, New York, NY, USA. pes9027@med.cornell.edu.
Zhen ZhaoDepartment of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA. zhz9010@med.cornell.edu.ORCID 0000-0002-9742-5982

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundGuidelines recommend high-sensitivity cardiac troponin (hs-cTn) for diagnosis of myocardial infarction. Use of hs-cTn is increasing across the U.S., but questions remain regarding clinical and operational impact. Prior studies have had methodologic limitations and yielded conflicting results.

objectiveTo evaluate the impact of transitioning from conventional cardiac troponin (cTn) to hs-cTn on test and resource utilization, operational efficiency, and patient safety.

designRetrospective cohort study in two New York City hospitals during the months before and after transition from conventional cTn to hs-cTn at Hospital 1. Hospital 2 served as a control.

participantsConsecutive emergency department (ED) patients with at least one cTn test resulted.

interventionMultifaceted hs-cTn intervention bundle, including a 0/2-h diagnostic algorithm for non-ST-elevation myocardial infarction, an educational bundle, enhancements to the electronic medical record, and nursing interventions to facilitate timed sample collection. MAIN MEASURES: Primary outcomes included serial cTn test utilization, probability of hospital admission, ED length of stay (LOS), and among discharged patients, probability of ED revisit within 72 h resulting in hospital admission. Multivariable regression models adjusted for age, sex, temporal trends, and interhospital differences. KEY

resultsThe intervention was associated with increased use of serial cTn testing (adjusted risk difference: 48 percentage points, 95% CI: 45-50, P < 0.001) and ED LOS (adjusted geometric mean difference: 50 min, 95% CI: 50-51, P < 0.001). There was no significant association between the intervention and probability of admission (adjusted relative risk [aRR]: 0.99, 95% CI: 0.89-1.1, P = 0.81) or probability of ED revisit within 72 h resulting in admission (aRR: 1.1, 95% CI: 0.44-2.9, P = 0.81).

conclusionsImplementation of a hs-cTn intervention bundle was associated with an improvement in serial cTn testing, a neutral effect on probability of hospital admission, and a modest increase in ED LOS.

Indexed as

Emergency Service, HospitalTroponin IAgedBiomarkersCohort StudiesFemaleHospitalizationHumansMaleMiddle AgedMyocardial InfarctionPatient AdmissionRetrospective StudiesBiomarkersTroponin Iadmissionemergency departmenthigh sensitivity cardiac troponinlength of staymyocardial infarctionpatient outcomestest utilization

Identifiers

PMID37993739
PMCPMC11043247

What OpenQuestion holds

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Registered trials

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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.