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.
OBJECTIVE
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.


METHODS
Pragmatic multicentre randomised controlled trial in six acute hospitals in the UK.


METHODS
Patients attending with acute chest pain due to suspected myocardial infarction (N=2243).


METHODS
Diagnostic assessment using a point-of-care biomarker panel consisting of creatine kinase, myocardial type, myoglobin and troponin I measured at baseline and 90&emsp14;min compared with standard care without the point-of-care panel.


METHODS
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&emsp14;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&emsp14;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.


BACKGROUND
Current controlled trials ISRCTN37823923.
Goodacre
Steve W
SW
School of Health and Related Research, University of Sheffield, Sheffield, UK. s.goodacre@sheffield.ac.uk.
Bradburn
Mike
M
Cross
Elizabeth
E
Collinson
Paul
P
Gray
Alasdair
A
Hall
Alistair S
AS
D000328:Adult; D015415:Biomarkers / Q000097:blood*; D052279:Creatine Kinase, MB Form / Q000097:blood; D004636:Emergency Service, Hospital; D004739:England; D004812:Epidemiologic Methods; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy; D009211:Myoglobin / Q000097:blood; D010351:Patient Discharge / Q000706:statistics & numerical data; D019095:Point-of-Care Systems; D012606:Scotland; D019210:Troponin I / Q000097:blood
D015415:Biomarkers; D009211:Myoglobin; D019210:Troponin I; D052279:Creatine Kinase, MB Form