The potential value of employing troponin POCT in the ED increases as the analytical sensitivity of the assays increases, with rule-out strategies for myocardial infarction now being reported down to one hour, albeit currently only with laboratory-based assays.
There are a large number of studies reporting on the performance of troponin POCT tests in the ED, summarized in ref 16 % of the studies reported an impact of POCT on mortality. Singer et al reviewed 41,256 admissions from the ED, finding that mortality “generally increased with increasing boarding time, from 2.5 % in patients boarded less than 2 hours to 4.5 % in patients boarding 12 hours or more (p 150 % increase in both hospital and Intensive Care Unit length of stay. Sun et al used bootstrap sampling to study nearly one million visits to the ED and found that overcrowding was associated with increased inpatient death. Overcrowding has impacts on the remainder of the hospital in which it is located but most importantly, it is associated with an adverse impact on patient mortality. Overcrowding in the Emergency Department (ED) is a widely acknowledged problem that is just one of the many pressures on the ED and has arisen through a number of causes, including an aging population and increasing referrals from primary care.
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