Methodology: 4/5
Usefulness: 3.5/5
Miller J, et al. Ann Emerg Med. 2024 Oct;84(4):399-408. doi: 10.1016/j.annemergmed.2024.04.024.
Question and Methods: The Authors assessed whether a 0/1-hour high-sensitivity troponin protocol increased safe ED discharges compared to standard 0/3-hour care, using a stepped-wedge, randomized trial across 9 US EDs.
Findings: The accelerated protocol did not significantly increase safe discharges (57.8% vs 59.5%; aOR=1.05, 95% CI 0.95–1.16) and was noninferior for 30-day death/MI (0.4% in both groups).
Limitations: Potential incomplete follow-up, COVID-19 impacts, variability across sites, and lack of HEART score data may affect generalizability and accuracy.
Interpretation: A 0/1-hour hs-cTnI protocol is safe and noninferior but does not significantly increase discharge rates; practice implementation should consider local context and patient factors.
By: Dr. Jessica Tat
JC Supervisor: Dr. Jeff Perry
