title: Point-of-care testing during medical emergency team activations: a pilot study.
abstract: OBJECTIVE
  To estimate the prognostic value of point-of-care measurement of biomarkers related to dyspnea in patients receiving a medical emergency team (MET) review.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  University affiliated hospital.
  
  
  METHODS
  Cohort of 95 patients receiving MET review over a six month period.
  
  
  METHODS
  We used a commercial multi-biomarker panel for shortness-of-breath (SOB panel) (Biosite Triage Profiler, Biosite Incorporated®), 9975 Summers Ridge Road, San Diego, CA 92121, USA) including Brain natriuretic peptide (BNP), D-dimer, myoglobin (Myo), creatine kinase MB isoenzyme (CK-MB) and troponin I (Tn-I). We recorded information about demographics, MET review triggers, and MET procedures and patient outcome.
  
  
  RESULTS
  Mean age was 70.5 (±15) years, 38 (41%) patients had a history of chronic heart failure (CHF) and 67 (70%) chronic kidney disease (CKD). At MET activation, 42 (44%) patients were dyspneic. The multi-biomarker panel was positive for at least one marker in 48 (51%) cases. BNP and D-dimer had a sensitivity of 0.79 and 0.93 for ICU admission with a negative predictive value (NPV) of 0.89 and 0.92 respectively. Thirty-five (37%) patients died. BNP was positive in 85% of such cases with sensitivity and NPV of 0.86 and 0.82, respectively. D-dimer was positive in 77% of non-survivors with a sensitivity and NPV of 0.94 and 0.88, respectively. BNP (area under the curve of receiver operating characteristic curve--AUC-ROC: 0.638) and D-dimer (AUC-ROC: 0.574) achieved poor discrimination of subsequent death. Similar findings applied to ICU admission. The combination of normal BNP and D-dimer levels completely ruled out ICU admission or death. The cardiac part of the panel was not useful in predicting ICU admission or mortality.
  
  
  CONCLUSIONS
  Although, BNP and D-dimer are poor discriminants of ICU admission and hospital mortality, normal BNP and D-dimer levels practically exclude subsequent need for ICU admission and hospital mortality.
authors.affiliation: Department of Intensive Care, Austin Hospital, Melbourne, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Calzavacca
authors.forename: E
authors.initials: E
authors.lastname: Licari
authors.forename: A
authors.initials: A
authors.lastname: Tee
authors.forename: R
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team; D010865:Pilot Projects; D019095:Point-of-Care Systems; D011446:Prospective Studies