Use of Cardiac Biomarker Testing in the Emergency Department. Makam, A. N. and Nguyen, O. K. JAMA Internal Medicine, 175(1):67–75, January, 2015.
Use of Cardiac Biomarker Testing in the Emergency Department [link]Paper  doi  abstract   bibtex   
\textlessh3\textgreaterImportance\textless/h3\textgreater\textlessp\textgreaterCardiac biomarker testing is not routinely indicated in the emergency department (ED) because of low utility and potential downstream harms from false-positive results. However, current rates of testing are unknown.\textless/p\textgreater\textlessh3\textgreaterObjective\textless/h3\textgreater\textlessp\textgreaterTo determine the use of cardiac biomarker testing overall, as well as stratified by disposition status and selected characteristics.\textless/p\textgreater\textlessh3\textgreaterDesign, Setting, and Participants\textless/h3\textgreater\textlessp\textgreaterRetrospective study of ED visits by adults (≥18 years old) selected from the 2009 and 2010 National Hospital Ambulatory Medical Care Survey, a probability sample of ED visits in the United States.\textless/p\textgreater\textlessh3\textgreaterExposures\textless/h3\textgreater\textlessp\textgreaterSelected patient, visit, and ED characteristics.\textless/p\textgreater\textlessh3\textgreaterMain Outcomes and Measures\textless/h3\textgreater\textlessp\textgreaterReceipt of cardiac biomarker testing during the ED visit.\textless/p\textgreater\textlessh3\textgreaterResults\textless/h3\textgreater\textlessp\textgreaterOf 44 448 ED visits, cardiac biomarkers were tested in 16.9% of visits, representing 28.6 million visits. Biomarker testing occurred in 8.2% of visits in the absence of acute coronary syndrome (ACS)–related symptoms, representing 8.5 million visits, almost one-third of all visits with biomarker testing. Among individuals subsequently hospitalized, cardiac biomarkers were tested in 47.0% of all visits. In this group, biomarkers were tested in 35.4% of visits despite the absence of ACS-related symptoms. Among all ED visits, the number of other tests or services performed was the strongest predictor of biomarker testing independent of symptoms of ACS. Compared with 0 to 5 other tests or services performed, more than 10 other tests or services performed was associated with 59.55 (95% CI, 39.23-90.40) times the odds of biomarker testing. The adjusted probabilities of biomarker testing if 0 to 5, 6 to 10, or more than 10 other tests or services performed were 6.3%, 34.3%, and 62.3%, respectively.\textless/p\textgreater\textlessh3\textgreaterConclusions and Relevance\textless/h3\textgreater\textlessp\textgreaterCardiac biomarker testing in the ED is common even among those without symptoms suggestive of ACS. Cardiac biomarker testing is also frequently used during visits with a high volume of other tests or services independent of the clinical presentation. More attention is needed to develop strategies for appropriate use of cardiac biomarkers.\textless/p\textgreater
@article{makam_use_2015,
	title = {Use of {Cardiac} {Biomarker} {Testing} in the {Emergency} {Department}},
	volume = {175},
	issn = {2168-6106},
	url = {https://jamanetwork-com.ezproxy.otago.ac.nz/journals/jamainternalmedicine/fullarticle/1935932},
	doi = {10.1001/jamainternmed.2014.5830},
	abstract = {{\textless}h3{\textgreater}Importance{\textless}/h3{\textgreater}{\textless}p{\textgreater}Cardiac biomarker testing is not routinely indicated in the emergency department (ED) because of low utility and potential downstream harms from false-positive results. However, current rates of testing are unknown.{\textless}/p{\textgreater}{\textless}h3{\textgreater}Objective{\textless}/h3{\textgreater}{\textless}p{\textgreater}To determine the use of cardiac biomarker testing overall, as well as stratified by disposition status and selected characteristics.{\textless}/p{\textgreater}{\textless}h3{\textgreater}Design, Setting, and Participants{\textless}/h3{\textgreater}{\textless}p{\textgreater}Retrospective study of ED visits by adults (≥18 years old) selected from the 2009 and 2010 National Hospital Ambulatory Medical Care Survey, a probability sample of ED visits in the United States.{\textless}/p{\textgreater}{\textless}h3{\textgreater}Exposures{\textless}/h3{\textgreater}{\textless}p{\textgreater}Selected patient, visit, and ED characteristics.{\textless}/p{\textgreater}{\textless}h3{\textgreater}Main Outcomes and Measures{\textless}/h3{\textgreater}{\textless}p{\textgreater}Receipt of cardiac biomarker testing during the ED visit.{\textless}/p{\textgreater}{\textless}h3{\textgreater}Results{\textless}/h3{\textgreater}{\textless}p{\textgreater}Of 44 448 ED visits, cardiac biomarkers were tested in 16.9\% of visits, representing 28.6 million visits. Biomarker testing occurred in 8.2\% of visits in the absence of acute coronary syndrome (ACS)–related symptoms, representing 8.5 million visits, almost one-third of all visits with biomarker testing. Among individuals subsequently hospitalized, cardiac biomarkers were tested in 47.0\% of all visits. In this group, biomarkers were tested in 35.4\% of visits despite the absence of ACS-related symptoms. Among all ED visits, the number of other tests or services performed was the strongest predictor of biomarker testing independent of symptoms of ACS. Compared with 0 to 5 other tests or services performed, more than 10 other tests or services performed was associated with 59.55 (95\% CI, 39.23-90.40) times the odds of biomarker testing. The adjusted probabilities of biomarker testing if 0 to 5, 6 to 10, or more than 10 other tests or services performed were 6.3\%, 34.3\%, and 62.3\%, respectively.{\textless}/p{\textgreater}{\textless}h3{\textgreater}Conclusions and Relevance{\textless}/h3{\textgreater}{\textless}p{\textgreater}Cardiac biomarker testing in the ED is common even among those without symptoms suggestive of ACS. Cardiac biomarker testing is also frequently used during visits with a high volume of other tests or services independent of the clinical presentation. More attention is needed to develop strategies for appropriate use of cardiac biomarkers.{\textless}/p{\textgreater}},
	language = {en},
	number = {1},
	urldate = {2018-03-17TZ},
	journal = {JAMA Internal Medicine},
	author = {Makam, Anil N. and Nguyen, Oanh K.},
	month = jan,
	year = {2015},
	keywords = {\_tablet},
	pages = {67--75}
}
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