Trial reportEmergency medicine Australasia : EMA2025
Health Services and Economic Impacts of the Limit of Detection in Emergency Department (LEGEND) Rule-Out Strategy in Australian Emergency Departments: A Stepped-Wedge Cluster Randomised Trial.
Trial report in Emergency medicine Australasia : EMA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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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.
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.
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Who cites it
1 citing paper in PubMed.
- Health Services and Economic Impacts of the Limit of Detection in Emergency Department (LEGEND) Rule-Out Strategy in Australian Emergency Departments: A Stepped-Wedge Cluster Randomised Trial.Emergency medicine Australasia : EMA · 2025Trial
Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
objectiveThis study aimed to describe healthcare utilisation and costs associated with the assessment of suspected acute coronary syndrome (ACS) under standard care and to compare these outcomes with the Limit of Detection in Emergency Department (LEGEND) strategy, an accelerated diagnostic pathway identifying low-risk patients using a single highly sensitive troponin (hs-cTnI).
methodA stepped-wedge cluster randomised trial was conducted in four Queensland hospitals. Each transitioned from standard care (2016 ACS guidelines) to the LEGEND intervention at randomised intervals. Data were collected for index presentations and 6-month outcomes.
resultsData were collected from 5347 patients in the standard care phase and 4597 in the LEGEND intervention phase. The intervention reduced mean ED length of stay (-72.0 min, 95% CI: -85.0 to -59.0 min) and inpatient admissions (-2.3%, 95% CI: -4.2% to -0.4%). For low-risk patients, the intervention further reduced ED length of stay (-97.0 min, 95% CI: -120.5 min to -73.5) and inpatient admissions (-4.2%, 95% CI: -6.9 to -1.6%). Exercise stress testing (EST) utilisation decreased by 3.6% (95% CI: 2.3%-4.9%) overall and 7.7% (95% CI: 5.0%-10.4%) among low-risk patients during the intervention phase. Total costs decreased from $6849 to $5794 per patient overall, saving $1055 per patient and from $2847 to $2129 per low-risk patient, saving $718 per patient.
conclusionsThe LEGEND strategy demonstrated reduced resource utilisation and costs compared to guideline-based ACS assessment, particularly for low-risk patients. Widespread adoption could improve the efficiency and cost-effectiveness of ACS assessment in the healthcare system.
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