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10.1136/heartjnl-2014-307288 http://scihub22266oqcxt.onion/10.1136/heartjnl-2014-307288 C4484040!4484040!25691511     free     free     free Warning: file_get_contents(https://eutils.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&id=25691511&cmd=llinks): Failed to open stream: HTTP request failed! 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A novel diagnostic protocol to identify patients suitable for discharge after a single high-sensitivity troponin |pdf=|usr=}}{{25691511}} gab.com Text A novel diagnostic protocol to identify patients suitable for discharge after a single high-sensitivity troponin JO: Heart http://www.kidney.de/pget.php?&tw=1&pmid=25691511 #FOAvip Objective: To establish whether a novel accelerated diagnostic protocol (ADP) for suspected acute coronary syndrome (ACS) could successfully identify low-risk patients suitable for discharge after a single high-sensitivity troponin T (hs-cTnT) taken at presentation to the emergency department. We also compared the diagnostic accuracy of this ADP with strategies using initial undetectable hs-cTnT. Methods: This prospective observational study evaluated the ability of the Triage Rule-out Using high-Sensitivity Troponin (TRUST) ADP to identify low-risk patients with suspected ACS. The ADP incorporated a single presentation hs-cTnT of <14?ng/L, a non-ischaemic ECG and a modified Goldman risk score. Diagnostic performance of the ADP was compared with the detection limit cut-offs of hs-cTnT (<5?ng/L and <3?ng/L). The primary end point was fatal/non-fatal acute myocardial infarction (AMI) within 30?days. Results: 960 participants were recruited, mean age 58.0?years, 80 (8.3%) had an AMI. The TRUST ADP classified 382 (39.8%) as low-risk with a sensitivity for identifying AMI of 98.8% (95% CI 92.5% to 99.9%). hs-cTnT detection limits (<5?ng/L and <3?ng/L) had a sensitivity of 100% (94.3 to 100) and 100% (94.4 to 100), respectively. The TRUST ADP identified more patients suitable for early discharge at 39.8% vs 29.3% (<5?ng/L) and 7.9% (<3?ng/L) (p<0.001) with a lower false-positive rate for AMI detection; specificity 43.3% (95% CI 42.7% to 43.4%) vs 32.0% (95% CI 31.5% to 32.0%) and 8.6% (95% CI 8.1% to 8.6%), respectively. Conclusions: The TRUST ADP, which incorporates structured risk-assessment and a single presentation hs-cTnT blood draw, has potential to allow early discharge in 40% of patients with suspected ACS and has greater clinical utility than undetectable hs-cTnT strategies. Trial registration number: ISRCTN No. 21109279. Twit Text FOAVip A novel diagnostic protocol to identify patients suitable for discharge after a single high-sensitivity troponin ????Heart http://www.kidney.de/pget.php?&tw=1&pmid=25691511 #FOAvip Twit Text # Free Paper on # # # # # LINK http://www.kidney.de/pget.php?&tw=1&pmid=25691511 #FOAvip English Wikipedia <ref>{{Cite pmid|25691511}}</ref> A novel diagnostic protocol to identify patients suitable for discharge after a single high-sensitivity troponin #MMPMID25691511 Carlton EW; Cullen L; Than M; Gamble J; Khattab A; Greaves K Heart 2015[Jul]; 101 (13): 1041-6 PMID25691511show ga Objective: To establish whether a novel accelerated diagnostic protocol (ADP) for suspected acute coronary syndrome (ACS) could successfully identify low-risk patients suitable for discharge after a single high-sensitivity troponin T (hs-cTnT) taken at presentation to the emergency department. We also compared the diagnostic accuracy of this ADP with strategies using initial undetectable hs-cTnT. Methods: This prospective observational study evaluated the ability of the Triage Rule-out Using high-Sensitivity Troponin (TRUST) ADP to identify low-risk patients with suspected ACS. The ADP incorporated a single presentation hs-cTnT of <14?ng/L, a non-ischaemic ECG and a modified Goldman risk score. Diagnostic performance of the ADP was compared with the detection limit cut-offs of hs-cTnT (<5?ng/L and <3?ng/L). The primary end point was fatal/non-fatal acute myocardial infarction (AMI) within 30?days. Results: 960 participants were recruited, mean age 58.0?years, 80 (8.3%) had an AMI. The TRUST ADP classified 382 (39.8%) as low-risk with a sensitivity for identifying AMI of 98.8% (95% CI 92.5% to 99.9%). hs-cTnT detection limits (<5?ng/L and <3?ng/L) had a sensitivity of 100% (94.3 to 100) and 100% (94.4 to 100), respectively. The TRUST ADP identified more patients suitable for early discharge at 39.8% vs 29.3% (<5?ng/L) and 7.9% (<3?ng/L) (p<0.001) with a lower false-positive rate for AMI detection; specificity 43.3% (95% CI 42.7% to 43.4%) vs 32.0% (95% CI 31.5% to 32.0%) and 8.6% (95% CI 8.1% to 8.6%), respectively. Conclusions: The TRUST ADP, which incorporates structured risk-assessment and a single presentation hs-cTnT blood draw, has potential to allow early discharge in 40% of patients with suspected ACS and has greater clinical utility than undetectable hs-cTnT strategies. Trial registration number: ISRCTN No. 21109279. äA novel diagnostic protocol to identify patients suitable for discharg(epmc).pdf DeepDyve Pubget Overpricing