Point-of-care testing during medical emergency team activations: A pilot study

P. Calzavacca, E. Licari, A. Tee, R. Bellomo

Research output: Contribution to journalArticleResearchpeer-review

7 Citations (Scopus)

Abstract

Objective: To estimate the prognostic value of point-of-care measurement of biomarkers related to dyspnea in patients receiving a medical emergency team (MET) review. Design: Prospective observational study. Setting: University affiliated hospital. Patients: Cohort of 95 patients receiving MET review over a six month period. Methods: We used a commercial multi-biomarker panel for shortness-of-breath (SOB panel) (Biosite Triage Profiler, Biosite Incorporated®, 9975 Summers Ridge Road, San Diego, CA 92121, USA) including Brain natriuretic peptide (BNP), D-dimer, myoglobin (Myo), creatine kinase MB isoenzyme (CK-MB) and troponin I (Tn-I). We recorded information about demographics, MET review triggers, and MET procedures and patient outcome. Results: Mean age was 70.5 (±15) years, 38 (41%) patients had a history of chronic heart failure (CHF) and 67 (70%) chronic kidney disease (CKD). At MET activation, 42 (44%) patients were dyspneic. The multi-biomarker panel was positive for at least one marker in 48 (51%) cases. BNP and D-dimer had a sensitivity of 0.79 and 0.93 for ICU admission with a negative predictive value (NPV) of 0.89 and 0.92 respectively. Thirty-five (37%) patients died. BNP was positive in 85% of such cases with sensitivity and NPV of 0.86 and 0.82, respectively. D-dimer was positive in 77% of non-survivors with a sensitivity and NPV of 0.94 and 0.88, respectively. BNP (area under the curve of receiver operating characteristic curve - AUC-ROC: 0.638) and D-dimer (AUC-ROC: 0.574) achieved poor discrimination of subsequent death. Similar findings applied to ICU admission. The combination of normal BNP and D-dimer levels completely ruled out ICU admission or death. The cardiac part of the panel was not useful in predicting ICU admission or mortality. Conclusions: Although, BNP and D-dimer are poor discriminants of ICU admission and hospital mortality, normal BNP and D-dimer levels practically exclude subsequent need for ICU admission and hospital mortality.

Original languageEnglish
Pages (from-to)1119-1123
Number of pages5
JournalResuscitation
Volume83
Issue number9
DOIs
Publication statusPublished - Sep 2012
Externally publishedYes

Keywords

  • Brain natriuretic peptide
  • Creatinine kinase
  • Critical illness
  • D-dimer
  • Medical emergency team
  • Mortality
  • Myoglobin
  • Rapid response system
  • Troponin I

Cite this

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title = "Point-of-care testing during medical emergency team activations: A pilot study",
abstract = "Objective: To estimate the prognostic value of point-of-care measurement of biomarkers related to dyspnea in patients receiving a medical emergency team (MET) review. Design: Prospective observational study. Setting: University affiliated hospital. Patients: Cohort of 95 patients receiving MET review over a six month period. Methods: We used a commercial multi-biomarker panel for shortness-of-breath (SOB panel) (Biosite Triage Profiler, Biosite Incorporated{\circledR}, 9975 Summers Ridge Road, San Diego, CA 92121, USA) including Brain natriuretic peptide (BNP), D-dimer, myoglobin (Myo), creatine kinase MB isoenzyme (CK-MB) and troponin I (Tn-I). We recorded information about demographics, MET review triggers, and MET procedures and patient outcome. Results: Mean age was 70.5 (±15) years, 38 (41{\%}) patients had a history of chronic heart failure (CHF) and 67 (70{\%}) chronic kidney disease (CKD). At MET activation, 42 (44{\%}) patients were dyspneic. The multi-biomarker panel was positive for at least one marker in 48 (51{\%}) cases. BNP and D-dimer had a sensitivity of 0.79 and 0.93 for ICU admission with a negative predictive value (NPV) of 0.89 and 0.92 respectively. Thirty-five (37{\%}) patients died. BNP was positive in 85{\%} of such cases with sensitivity and NPV of 0.86 and 0.82, respectively. D-dimer was positive in 77{\%} of non-survivors with a sensitivity and NPV of 0.94 and 0.88, respectively. BNP (area under the curve of receiver operating characteristic curve - AUC-ROC: 0.638) and D-dimer (AUC-ROC: 0.574) achieved poor discrimination of subsequent death. Similar findings applied to ICU admission. The combination of normal BNP and D-dimer levels completely ruled out ICU admission or death. The cardiac part of the panel was not useful in predicting ICU admission or mortality. Conclusions: Although, BNP and D-dimer are poor discriminants of ICU admission and hospital mortality, normal BNP and D-dimer levels practically exclude subsequent need for ICU admission and hospital mortality.",
keywords = "Brain natriuretic peptide, Creatinine kinase, Critical illness, D-dimer, Medical emergency team, Mortality, Myoglobin, Rapid response system, Troponin I",
author = "P. Calzavacca and E. Licari and A. Tee and R. Bellomo",
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Point-of-care testing during medical emergency team activations : A pilot study. / Calzavacca, P.; Licari, E.; Tee, A.; Bellomo, R.

In: Resuscitation, Vol. 83, No. 9, 09.2012, p. 1119-1123.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Point-of-care testing during medical emergency team activations

T2 - A pilot study

AU - Calzavacca, P.

AU - Licari, E.

AU - Tee, A.

AU - Bellomo, R.

PY - 2012/9

Y1 - 2012/9

N2 - Objective: To estimate the prognostic value of point-of-care measurement of biomarkers related to dyspnea in patients receiving a medical emergency team (MET) review. Design: Prospective observational study. Setting: University affiliated hospital. Patients: Cohort of 95 patients receiving MET review over a six month period. Methods: We used a commercial multi-biomarker panel for shortness-of-breath (SOB panel) (Biosite Triage Profiler, Biosite Incorporated®, 9975 Summers Ridge Road, San Diego, CA 92121, USA) including Brain natriuretic peptide (BNP), D-dimer, myoglobin (Myo), creatine kinase MB isoenzyme (CK-MB) and troponin I (Tn-I). We recorded information about demographics, MET review triggers, and MET procedures and patient outcome. Results: Mean age was 70.5 (±15) years, 38 (41%) patients had a history of chronic heart failure (CHF) and 67 (70%) chronic kidney disease (CKD). At MET activation, 42 (44%) patients were dyspneic. The multi-biomarker panel was positive for at least one marker in 48 (51%) cases. BNP and D-dimer had a sensitivity of 0.79 and 0.93 for ICU admission with a negative predictive value (NPV) of 0.89 and 0.92 respectively. Thirty-five (37%) patients died. BNP was positive in 85% of such cases with sensitivity and NPV of 0.86 and 0.82, respectively. D-dimer was positive in 77% of non-survivors with a sensitivity and NPV of 0.94 and 0.88, respectively. BNP (area under the curve of receiver operating characteristic curve - AUC-ROC: 0.638) and D-dimer (AUC-ROC: 0.574) achieved poor discrimination of subsequent death. Similar findings applied to ICU admission. The combination of normal BNP and D-dimer levels completely ruled out ICU admission or death. The cardiac part of the panel was not useful in predicting ICU admission or mortality. Conclusions: Although, BNP and D-dimer are poor discriminants of ICU admission and hospital mortality, normal BNP and D-dimer levels practically exclude subsequent need for ICU admission and hospital mortality.

AB - Objective: To estimate the prognostic value of point-of-care measurement of biomarkers related to dyspnea in patients receiving a medical emergency team (MET) review. Design: Prospective observational study. Setting: University affiliated hospital. Patients: Cohort of 95 patients receiving MET review over a six month period. Methods: We used a commercial multi-biomarker panel for shortness-of-breath (SOB panel) (Biosite Triage Profiler, Biosite Incorporated®, 9975 Summers Ridge Road, San Diego, CA 92121, USA) including Brain natriuretic peptide (BNP), D-dimer, myoglobin (Myo), creatine kinase MB isoenzyme (CK-MB) and troponin I (Tn-I). We recorded information about demographics, MET review triggers, and MET procedures and patient outcome. Results: Mean age was 70.5 (±15) years, 38 (41%) patients had a history of chronic heart failure (CHF) and 67 (70%) chronic kidney disease (CKD). At MET activation, 42 (44%) patients were dyspneic. The multi-biomarker panel was positive for at least one marker in 48 (51%) cases. BNP and D-dimer had a sensitivity of 0.79 and 0.93 for ICU admission with a negative predictive value (NPV) of 0.89 and 0.92 respectively. Thirty-five (37%) patients died. BNP was positive in 85% of such cases with sensitivity and NPV of 0.86 and 0.82, respectively. D-dimer was positive in 77% of non-survivors with a sensitivity and NPV of 0.94 and 0.88, respectively. BNP (area under the curve of receiver operating characteristic curve - AUC-ROC: 0.638) and D-dimer (AUC-ROC: 0.574) achieved poor discrimination of subsequent death. Similar findings applied to ICU admission. The combination of normal BNP and D-dimer levels completely ruled out ICU admission or death. The cardiac part of the panel was not useful in predicting ICU admission or mortality. Conclusions: Although, BNP and D-dimer are poor discriminants of ICU admission and hospital mortality, normal BNP and D-dimer levels practically exclude subsequent need for ICU admission and hospital mortality.

KW - Brain natriuretic peptide

KW - Creatinine kinase

KW - Critical illness

KW - D-dimer

KW - Medical emergency team

KW - Mortality

KW - Myoglobin

KW - Rapid response system

KW - Troponin I

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