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Diagnostic Performance of Prehospital Point-of-Care Troponin Tests to Rule Out Acute Myocardial Infarction: A Systematic Review

Part of: Technology Developments in Prehospital and Disaster Medicine

Published online by Cambridge University Press:  09 July 2020

Abdulrhman Alghamdi Open the ORCID record for Abdulrhman Alghamdi [Opens in a new window] ,
Ahmed Alotaibi ,
Meshal Alharbi ,
Charles Reynard  and
Richard Body
Abdulrhman Alghamdi*
Affiliation:
Division of Cardiovascular Sciences, University of Manchester, Manchester, UK College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabi
Ahmed Alotaibi
Affiliation:
Division of Cardiovascular Sciences, University of Manchester, Manchester, UK College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabi
Meshal Alharbi
Affiliation:
College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabi Division of Cardiovascular Sciences, University of Leicester, Leicestershire, UK
Charles Reynard
Affiliation:
Division of Cardiovascular Sciences, University of Manchester, Manchester, UK Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
Richard Body
Affiliation:
Division of Cardiovascular Sciences, University of Manchester, Manchester, UK Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
*
Correspondence: Abdulrhman Alghamdi, MSc, Division of Cardiovascular Sciences, The University of Manchester, 46 Grafton Street, Manchester, M13 9PL, United Kingdom, E-mail: ghamdia@ksau-hs.edu.sa
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Abstract

Introduction:

Chest pain is one of the most common reasons for 999 calls and transfers to the emergency department (ED). In these patients, acute myocardial infarction (AMI) is often the diagnosis that clinicians are seeking to exclude. However, only a minority of those patients have AMI, causing a substantial financial burden to health services. Cardiac troponin (cTn) is the reference standard biomarker for the diagnosis of AMI. Several commercially available point-of-care (POC) cTn assays are portable and could feasibly be used in an ambulance. The aim of this paper is to systematically review existing evidence for the use of POC cTn assays in the prehospital setting to rule out AMI.

Methods:

A systematic search was conducted on EMBASE, MEDLINE, and CINAHL Plus databases, reference lists, and relevant grey literature, including combinations of the relevant terms. Papers published in English language since the year 2000 were eligible for inclusion. A narrative synthesis of the evidence was then undertaken.

Results:

The initial search and cross-referencing revealed a total of 350 papers, of which 243 were excluded. Seven papers were included in the systematic literature review.

Conclusion:

Current evidence does not support the use of POC troponin assays to exclude AMI due to issues with diagnostic accuracy and insufficient high-quality evidence.

Keywords

biomarkerschest painmyocardial infarctionparamedic
Type
Systematic Review
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 5 , October 2020 , pp. 567 - 573
Copyright
© World Association for Disaster and Emergency Medicine 2020

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