A prospective randomized controlled trial of point-of-care testing on the coronary care unit.
BACKGROUND
We report the results of a prospective randomized controlled trial comparing point-of-care testing (POCT) with central laboratory testing (CLT) in a six-bed coronary care unit in a district general hospital.


METHODS
263 consecutive admissions with chest pain and suspected acute coronary syndrome were randomized to measurement of cardiac troponin T by POCT or CLT only. Patient management was according to a pre-specified protocol utilizing clinical features, electrocardiographic changes and cardiac biomarkers (creatine kinase and cardiac troponin T) to define management. Outcome measures were diagnostic accuracy compared with CLT as 'gold standard', result turnaround time, mortality and length of stay in all patients and those with a protocol-driven early discharge policy.


RESULTS
Diagnostic accuracy and mortality was equivalent in the POCT and CLT arm. Overall there was no difference in length of stay. In the pre-specified early discharge group (n = 64) there was a significant reduction in median length of non-coronary care unit stay (145.3 h versus 79.5 h) and overall hospital stay (209.3 h versus 149.9 h) in those randomized to POCT.


CONCLUSIONS
A combination of rapid biochemical diagnosis and structured decision making reduces length of hospital stay.
Collinson
P O
PO
Department of Chemical Pathology, Mayday University Hospital, Croydon, Surrey CR7 7YE, UK. paul.collinson@stgeorges.nhs.uk
John
C
C
Lynch
S
S
Rao
A
A
Canepa-Anson
R
R
Carson
E
E
Cramp
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000175:diagnosis / Q000453:epidemiology; D016001:Confidence Intervals; D003325:Coronary Care Units / Q000379:methods / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors