Comparing Outcomes of a Rapid High-Sensitivity Troponin Protocol Between Hospital-Based and Freestanding Emergency Departments
Recommended Citation
Gunaga S, Miller J, Cook B, Gandolfo C, Hawatian K, Brennan B, Husain A, Nasseredine H, Tuttle J, Sidani M, Mahler S, Levy P, Parikh S, Krupp S, Nour K, Klausner H, Gindi R, Lewandowski A, Hudson M, Perrotta G, Zweig B, Lanfear D, Kim H, Morton T, Bills G, Vieder J, Rockoff S, Colucci A, Kim B, Plemmons E, and McCord J. Comparing Outcomes of a Rapid High-Sensitivity Troponin Protocol Between Hospital-Based and Freestanding Emergency Departments. Acad Emerg Med 2025;33(3):70210.
Document Type
Article
Publication Date
3-1-2026
Publication Title
Academic emergency medicine
Keywords
Humans, Emergency Service, Hospital, Male, Female, Myocardial Infarction, Middle Aged, Aged, Troponin I, Biomarkers, Troponin, Patient Discharge
Abstract
STUDY OBJECTIVES: Significant variability exists in patient populations and diagnostic capabilities among hospital-based emergency departments (HBEDs) and freestanding emergency departments (FSEDs). While high sensitivity cardiac troponin (hs-cTn) research has focused on HBEDs, its application in FSEDs remains unexplored. This study assesses the comparative, real-world effectiveness of a 0/1-h accelerated protocol (AP) using hs-cTn between HBEDs and FSEDs.
METHODS: We conducted a pre-planned, secondary analysis of a stepped-wedge cluster randomized trial involving nine EDs within an integrated health system, from July 2020 to March 2021, comprised of five HBEDs and four FSEDs. The trial implemented a 0/1-h AP utilizing hs-cTnI to evaluate acute myocardial infarction (AMI). Adult ED patients with an ECG and cardiac troponin ordered were eligible, excluding those with STEMI, hs-cTnI > 18 ng/L, or trauma-related symptoms. The primary outcome was safe ED discharge, defined as discharge without death or AMI within 30 days.
RESULTS: The trial included 32,609 patients, 26,957 in HBEDs and 5652 in FSEDs. Safe discharge from HBED occurred 53.7% (5935/11,062) of the time in the standard care arm and 50.3% (7991/15895) under the AP (aOR 1.04, 95% CI 0.94-1.15, p = 0.50). Safe discharge from a FSED occurred 86.0% (2102/2443) of the time in the standard care arm and increased to 95.0% (3049/3209) under the AP (aOR 1.48, 95% CI 1.03-2.13, p = 0.033). Overall, the observed association between the AP and safe discharge was stronger in FSEDs than in HBEDs ( Δ log(aOdds) 1.05, 95% CI (0.82, 1.29), p < 0.001).
CONCLUSION: Implementing a 0/1-h AP using hs-cTnI to evaluate for AMI was associated with higher rates of safe discharge in FSEDs compared to HBEDs.
Medical Subject Headings
Humans; Emergency Service, Hospital; Male; Female; Myocardial Infarction; Middle Aged; Aged; Troponin I; Biomarkers; Troponin; Patient Discharge
PubMed ID
41437417
ePublication
ePub ahead of print
Volume
33
Issue
3
First Page
70210
Last Page
70210
