Use of Cardiac Biomarker Testing in the Emergency Department. Makam, A. N. & Nguyen, O. K. JAMA Internal Medicine, 175(1):67–75, January, 2015. 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}
}
Downloads: 0
{"_id":"ZYYMdvHYYpQ8Fw9hc","bibbaseid":"makam-nguyen-useofcardiacbiomarkertestingintheemergencydepartment-2015","downloads":0,"creationDate":"2019-01-13T08:37:46.652Z","title":"Use of Cardiac Biomarker Testing in the Emergency Department","author_short":["Makam, A. N.","Nguyen, O. K."],"year":2015,"bibtype":"article","biburl":"https://bibbase.org/zotero/Rory.miller","bibdata":{"bibtype":"article","type":"article","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":"\\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","language":"en","number":"1","urldate":"2018-03-17TZ","journal":"JAMA Internal Medicine","author":[{"propositions":[],"lastnames":["Makam"],"firstnames":["Anil","N."],"suffixes":[]},{"propositions":[],"lastnames":["Nguyen"],"firstnames":["Oanh","K."],"suffixes":[]}],"month":"January","year":"2015","keywords":"_tablet","pages":"67–75","bibtex":"@article{makam_use_2015,\n\ttitle = {Use of {Cardiac} {Biomarker} {Testing} in the {Emergency} {Department}},\n\tvolume = {175},\n\tissn = {2168-6106},\n\turl = {https://jamanetwork-com.ezproxy.otago.ac.nz/journals/jamainternalmedicine/fullarticle/1935932},\n\tdoi = {10.1001/jamainternmed.2014.5830},\n\tabstract = {{\\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}},\n\tlanguage = {en},\n\tnumber = {1},\n\turldate = {2018-03-17TZ},\n\tjournal = {JAMA Internal Medicine},\n\tauthor = {Makam, Anil N. and Nguyen, Oanh K.},\n\tmonth = jan,\n\tyear = {2015},\n\tkeywords = {\\_tablet},\n\tpages = {67--75}\n}\n\n","author_short":["Makam, A. N.","Nguyen, O. 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