2001 OPEN FORUM Abstracts
A RETROSPECTIVE RANDOMIZEDCOMPARISON OF CORRELATION AND TURNAROUND TIMES IN SERIAL TESTING OF CARDIACMARKERS PERFORMED BY RESPIRATORY CARE PRACTITIONERS UTILIZING A POINT OF CARETESTING DEVICE (TRIAGE®, BIOSITE DIAGNOSTICS) TO CLINICAL LABORATORY BECKMANCX7 AND BAYER ACS 180.
Stanley M. Baldwin,MBA, RRT, Elizabeth Fischer, RPFT, Daniel G. Walters, M.D., Department ofPulmonary Services, Desert Regional Medical Center, Palm Springs, CA.
Background: Early and accurateevaluation for patients with chest pain is critically important for their appropriatetriage and management. Point of care testing (Triage®, Biosite) coupled withdiagnostic algorithms have shown that 100% of Acute Myocardial Infarction canbe diagnosed by 90 minutes. In addition, Press-Ganey data shows a strong correlationbetween patient dissatisfaction and longer Emergency Department waiting times.One of several improvements would be to expedite laboratory data to the physiciansto decrease time to patient disposition. This study compared correlation andturnaround times of point of care Triage® device from Biosite Diagnostics withanalysis done by respiratory care practitioners in the Emergency Departmentto Beckman CX7 and Bayer ACS 180 in the clinical laboratory setting.
Methods: 30 paired data turnaroundtimes from draw time to being reported to the physician were selected usinga table of random numbers. Correlation of the two methodologies was done byparallel study of 35 blood samples. Troponin I and Myoglobin were analyzed byBayer ACS 180 and CK MB by Beckman CX7 in the clinical lab. Both clinical laboratoriesuse serum. The Triage Meter® ran all three cardiac markers (Troponin I, CKMB,Myoglobin) from whole blood. The device is classified as moderately complex,allowing testing to be done by respiratory care practitioners. Statistical analysisusing a t-test to compare turnaround time and a correlation co-efficient wascalculated for regression analysis of all three cardiac markers and mean differenceto determine bias.
|Serum Sample||Whole BloodSample||RegressionAnalysis|
|CKMB||1.94||3.26 +9.4||5.19 +14.13||0.99|
|Myoglobin||36.20||80.2 +109.7||116.4 +98.40||0.94|
|Troponin I||-0.30||0.513 +1.9||0.210 +0.44||0.99|
|0.97 = Mean|
|Turnaround Time (minutes)||59.06 +18.34||34.83 +19.01||P< 0.01|
Results: The correlation betweenthe two devices using different methodologies was high with an average R=0.97for the three markers. The turnaround time for results was statistically significantwith a P<0.01 for cardiac markers being done point of care by respiratorycare practitioners in the emergency department versus the clinical laboratory.
Conclusion: The use of a pointof care device by trained respiratory care practitioners to measure TroponinI, Myoglobin, and CKMB cardiac markers can significantly reduce turnaround timeof critical data to physicians and reach a target time of 90 minutes to assesschest pain.