Written by Joshua Belfer
Spoon Feed
Point-of-care high-sensitivity troponin testing didn’t meaningfully reduce ED length of stay compared to central lab testing using a 0/1-hour protocol––but it didn’t impact safety outcomes either.
New test, same wait
Emergency departments are flooded with chest pain complaints, and high-sensitivity troponin (hs-cTn) has revolutionized how we rule out acute coronary syndrome (ACS). The idea of bedside testing sounds great––less waiting, faster decisions. But can point-of-care (POC) hs-cTn actually shorten ED length of stay?
This single-center RCT (n = 1,494) randomized patients with possible ACS to either 0/1-hour POC hs-cTnI or standard lab-based hs-cTnT testing. The primary outcome––ED length of stay (LOS)––was 174 minutes in the POC group vs. 180 minutes in the control group, a non-significant 6-minute difference (95%CI –4 to 17). No difference was found in 30-day safety outcomes (acute MI, death, or revascularization). Roughly 5% had a final diagnosis of NSTEMI.
Limitations include its single-center setting in Norway, which may limit generalizability. Also, the POC assay lacked a validated 0/1 rule-in/out algorithm at the time, which may have hampered effectiveness. Notably, nearly 28% of POC patients still had central troponin results ordered “just in case.”
How will this change my practice?
High-sensitivity troponins have been studied extensively, but this paper tackles a key question: Can we streamline testing for one of the most common ED complaints in a way that meaningfully reduces length of stay? Unfortunately, point-of-care troponin testing isn’t the silver bullet––yet. Still, this study may serve as a nudge for systems to build protocols that actually unlock the potential of rapid bedside testing.
Source
Effectiveness of Point-of-Care High-Sensitivity Troponin Testing in the Emergency Department: A Randomized Controlled Trial. Ann Emerg Med. 2025 Aug;86(2):124-135. doi: 10.1016/j.annemergmed.2025.03.005. Epub 2025 Apr 9. PMID: 40202469.
