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JOURNAL ARTICLE
MULTICENTER STUDY
RANDOMIZED CONTROLLED TRIAL
RESEARCH SUPPORT, NON-U.S. GOV'T
The Randomised Assessment of Treatment using Panel Assay of Cardiac Markers (RATPAC) trial: a randomised controlled trial of point-of-care cardiac markers in the emergency department.
Heart 2011 Februrary
OBJECTIVES: To determine whether using a point-of-care cardiac biomarker panel would increase the rate of successful discharge home after emergency department assessment, and affect the use of cardiac tests and treatments, subsequent attendance at or admission to hospital and major adverse events.
DESIGN AND SETTING: Pragmatic multicentre randomised controlled trial in six acute hospitals in the UK.
PARTICIPANTS: Patients attending with acute chest pain due to suspected myocardial infarction (N=2243).
INTERVENTIONS: Diagnostic assessment using a point-of-care biomarker panel consisting of creatine kinase, myocardial type, myoglobin and troponin I measured at baseline and 90 min compared with standard care without the point-of-care panel.
MAIN OUTCOME MEASURES: The primary outcome was successful discharge home, defined as having left hospital or awaiting transport home by 4 h after attendance and no major adverse events up to 3 months. Secondary outcome measures included length of stay, use of coronary care, cardiac interventions and inpatient beds, emergency department attendances, subsequent admissions, outpatient visits and major adverse events.
RESULTS: Point-of-care panel assessment was associated with an increased rate of successful discharge (358/1125 (32%) vs 146/1118 (13%); OR 3.81, 95% CI 3.01 to 4.82; p<0.001), reduced median length of initial hospital stay (8.8 vs 14.2 h; p<0.001) and greater use of coronary care (50/1125 (4.0%) vs 31/1118 (3.0%); p=0.041), but no difference in mean length of initial stay (29.6 vs 31.7 h; p=0.462), mean inpatient days over follow-up (1.8 vs 1.7; p=0.815) or major adverse events (36 (3%) vs 26 (2%); OR 1.31, 95% CI 0.78 to 2.20; p=0.313).
CONCLUSIONS: Point-of-care panel assessment increases successful discharge home and reduces median length of stay, but does not alter overall hospital bed use.
TRIAL REGISTRATION: Current controlled trials ISRCTN37823923.
DESIGN AND SETTING: Pragmatic multicentre randomised controlled trial in six acute hospitals in the UK.
PARTICIPANTS: Patients attending with acute chest pain due to suspected myocardial infarction (N=2243).
INTERVENTIONS: Diagnostic assessment using a point-of-care biomarker panel consisting of creatine kinase, myocardial type, myoglobin and troponin I measured at baseline and 90 min compared with standard care without the point-of-care panel.
MAIN OUTCOME MEASURES: The primary outcome was successful discharge home, defined as having left hospital or awaiting transport home by 4 h after attendance and no major adverse events up to 3 months. Secondary outcome measures included length of stay, use of coronary care, cardiac interventions and inpatient beds, emergency department attendances, subsequent admissions, outpatient visits and major adverse events.
RESULTS: Point-of-care panel assessment was associated with an increased rate of successful discharge (358/1125 (32%) vs 146/1118 (13%); OR 3.81, 95% CI 3.01 to 4.82; p<0.001), reduced median length of initial hospital stay (8.8 vs 14.2 h; p<0.001) and greater use of coronary care (50/1125 (4.0%) vs 31/1118 (3.0%); p=0.041), but no difference in mean length of initial stay (29.6 vs 31.7 h; p=0.462), mean inpatient days over follow-up (1.8 vs 1.7; p=0.815) or major adverse events (36 (3%) vs 26 (2%); OR 1.31, 95% CI 0.78 to 2.20; p=0.313).
CONCLUSIONS: Point-of-care panel assessment increases successful discharge home and reduces median length of stay, but does not alter overall hospital bed use.
TRIAL REGISTRATION: Current controlled trials ISRCTN37823923.
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