A Decision Support System is Needed for Rapid Triage of Chest Pain Patients Using High
Sensitivity Troponin Testing-Based Algorithms.
Cardiovascular disease is a leading cause of mortality and morbidity worldwide.
In 2013, an estimated ,million people died from acute myocardial infarction globally.
Emergency department is the main portal of entry for patients with acute chest pain symptoms.
Approximately 10% of all emergency department patients presented with chest pain complaint.
Contemporary troponin assay could not detect the presence of cardiac troponins in t
he peripheral circulation until 6 to 8 hours after the onset of MI. Therefore,
patients presenting to the ED with chest pain usually require serial troponin measurements over
6 to 8 hours before the possibility of MI can be safely excluded.
The introduction of high sensitive cardiac troponin assays in 2010 has shown promise
to enhance the accuracy and efficiency of MI diagnosis in the ED tremendously.
Several accelerated diagnosis algorithms, such as 0-, 1-, or 2-hour algorithm, have been
developed and implemented based on the high sensitivity nature
of new generation troponins.
Despite the rapid development of various high sensitivity
troponin testing based accelerated diagnosis system, the implementation of the newly developed algorithms in ED have been slow.
One of the big obstacle is the complexity of the algorithms that
include several cutoff values of troponin at several time points.
The addition of scoring systems and multiple markers strategy further complicates the decision process. Because the hospital central
laboratory conventionally reports only the test results with reference value, an emergency physician therefore, has to memorize the
complex algorithms. The 1-hour algorithm is a very good example
that a clinical decision support system will help clinicians make
Emerg Med Open J. 2019; 5(1): e1-e2. doi: 10.17140/EMOJ-5-e006