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Trial is error? Evaluating the effectiveness of single-troponin diagnostic pathways
  1. Richard Body1,2
  1. 1 Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
  2. 2 Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK
  1. Correspondence to Prof Richard Body, Emergency Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester M13 9WL, UK; richard.body{at}

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The most tangible benefit of implementing high-sensitivity cardiac troponin (hs-cTn) assays is the potential to reduce length of stay for patients presenting to the hospital with symptoms compatible with acute myocardial infarction (AMI). There is now abundant evidence to demonstrate the high diagnostic accuracy of rapid diagnostic algorithms that aim to identify patients who have a very low probability of AMI within just a few hours of arriving in the emergency department (ED).

By using very low cut-offs set at or close to the limit of detection (LoD) of hs-cTn assays, a single blood test is sufficient to ‘rule out’ the diagnosis of AMI for many patients.1 2 Those patients do not require any further inpatient investigation and may be suitable for immediate discharge, allowing the patients to benefit from earlier reassurance and relieving ED crowding.

The ‘single-test’ strategy has substantial potential benefit for busy EDs. Avoiding a second venepuncture saves staff time. Further, more patients will have all the necessary investigation results to hand at the time of their consultation with a clinician. If clinicians do not have that information to hand, they are more likely to see new patients and are less …

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  • Contributors RB is the sole author of this work.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests Speaker fees from Singulex, Roche, Abbott, Siemens, Beckman, Ortho, ET Healthcare and Alere; research grants from Roche, Abbott Point of Care and Singulex; donation of reagents for research from Roche, Siemens, Singulex, Abbott, Alere, FABPulous BV, Beckman and Abbott Point of Care.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Provenance and peer review Commissioned; internally peer reviewed.

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