The impact of prehospital blood sampling on the emergency department process of patients with chest pain: a pragmatic non-randomized controlled trial

doi:10.5847/wjem.j.1920-8642.2023.054

Abstract

Abstract:

BACKGROUND: In patients with chest pain who arrive at the emergency department (ED) by ambulance, venous access is frequently established prehospital, and could be utilized to sample blood. Prehospital blood sampling may save time in the diagnostic process. In this study, the association of prehospital blood draw with blood sample arrival times, troponin turnaround times, and ED length of stay (LOS), number of blood sample mix-ups and blood sample quality were assessed.
METHODS: The study was conducted from October 1, 2019 to February 29, 2020. In patients who were transported to the ED with acute chest pain with low suspicion for acute coronary syndrome (ACS), outcomes were compared between cases, in whom prehospital blood draw was performed, and controls, in whom blood was drawn at the ED. Regression analyses were used to assess the association of prehospital blood draw with the time intervals.
RESULTS: Prehospital blood draw was performed in 100 patients. In 406 patients, blood draw was performed at the ED. Prehospital blood draw was independently associated with shorter blood sample arrival times, shorter troponin turnaround times and decreased LOS (P<0.001). No differences in the number of blood sample mix-ups and quality were observed (P>0.05).
CONCLUSION: For patients with acute chest pain with low suspicion for ACS, prehospital blood sampling is associated with shorter time intervals, while there were no significant differences between the two groups in the validity of the blood samples.

Key words: Blood specimen collection, Crowding, Emergency medical services, Troponin

Johan L. van Nieuwkerk, M. Christien van der Linden, Rolf J. Verheul, Merel van Loon-van Gaalen, Marije Janmaat, Naomi van der Linden. The impact of prehospital blood sampling on the emergency department process of patients with chest pain: a pragmatic non-randomized controlled trial[J]. World Journal of Emergency Medicine, 2023, 14(4): 257-264.

Figures/Tables 5

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References 23

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Variables	Cases (n=100)	Controls (n=406)	Odds ratio	95% CI	P-value^a
Assessment at general ED, n (%)	42 (42.0)	202 (49.8)	0.73	0.47-1.14	0.17
Assessment at chest pain unit, n (%)	58 (58.0)	204 (50.2)
Age, years, median (IQR)	64 (50-77)	64 (53-75)			0.98
Gender, male, n (%)	40 (40.0)	196 (48.3)	1.40	0.90-2.19	0.14
Medical history, n/total known (%)
Diabetes^b	28/98 (28.6)	49/207 (23.7)	0.78	0.45-1.33	0.36
Hypertension^c	45/98 (45.9)	75/205 (36.6)	0.68	0.42-1.11	0.12
Dyslipidemia^d	31/88 (35.2)	88/201 (43.8)	1.43	0.85-2.41	0.17
Prior cardiovascular disease^e	36/98 (36.7)	101/104 (49.5)	1.69	1.03-2.77	0.04
Family history of cardiac events^f	24/47 (51.1)	47/98 (48.0)	0.88	0.44-1.77	0.73
Smoking history^g, n/total known (%)					0.19
Current	17/53 (32.1)	44/119 (37.0)
Former	19/53 (35.8)	27/119 (22.7)
Never	17/53 (32.1)	48/119 (40.3)
Arrival time, n (%)					0.04
Day shift (8 am to 4 pm)	21 (21.0)	111 (27.3)
Evening shift (4 pm to midnight)	47 (47.0)	135 (33.3)
Night shift (midnight to 8 am)	32 (32.0)	160 (39.4)
Arrival during extreme busyness^h	22 (22.0)	99 (24.4)	0.88	0.52-1.48	0.62
Troponin result, n (%)					0.14
Normal	62 (62.0)	273 (67.4)
Elevated	29 (29.0)	82 (20.2)
Strongly elevated	9 (9.0)	50 (12.3)
Radiology requests, n (%)			0.73	0.42-1.26	0.25
None	81 (81.0)	307 (75.6)
One or two	19 (19.0)	99 (24.4)
Hospital admission, n (%)	65 (65.0)	258 (63.5)	1.07	0.67-1.68	0.79

Time intervals	Cases (n=100)	Controls (n=406)	P-value
Total study population
Blood sample arrival time, min, median (IQR) ^a	13 (8.3-18.8)	26 (19.0-34.0)	<0.001
Troponin turnaround time, min, median (IQR) ^a	53 (42.3-66.0)	64 (53.0-81.0)	<0.001
Patients who were assessed at the general ED	Cases (n=42)	Controls (n=202)
EDLOS, min, median (IQR)^a	180 (126-222)	181 (134-227)	0.26

Factors	Initial model			Final model
Factors	B	95% CI	P-value^a	B	95% CI	P-value^a
Constant	1.50	1.24 - 1.77	<0.001	1.73	1.70 - 1.75	<0.001
Prehospital blood draw	-0.08	-0.17 - -0.04	0.06	-0.10	-0.13 - -0.07	<0.001
Age	-0.001	-0.003 - 0.002	0.62
Gender, male	-0.04	-0.10 - 0.03	0.27
Smoking history	0.02	-0.02 - 0.06	0.26
Diabetes mellitus	0.05	-0.04 - 0.14	0.29
Hypertension	0.005	-0.07 - 0.08	0.90
Dyslipidemia	0.06	-0.04 - 0.15	0.23
Prior cardiovascular disease	-0.003	-0.09 - 0.09	0.94
Family history of coronary disease	0.001	-0.06 - 0.06	0.799
Arrival at day shift	-0.03	-0.10 - 0.05	0.48
Arrival at evening shift	0.08	-0.03 - 0.19	0.17	0.09	0.07 - 0.12	<0.001
Busyness at arrival	0.001	-0.001 - 0.002	0.47
Troponin result	0.09	0.02 - 0.17	0.02	0.06	0.04 - 0.07	<0.001
Second troponin draw	-0.02	-0.10 - 0.05	0.56
Radiology request	-0.03	-0.09 - 0.04	0.45
Hospital admission	0.001	-0.10 - 0.10	0.99	-0.03	-0.06 - 0.00	0.046

Factors	Initial model			Final model
Factors	B	95% CI	P-value^a	B^b	95% CI	P-value^a
Constant	2.25	1.99 - 2.51	<0.001	2.09	2.01 -2.17	<0.001
Prehospital blood draw	-0.02	-0.10 - 0.06	0.59	-0.10	-0.16 - -0.04	0.001
Age	0.003	0.001 - 0.005	<0.001	0.002	0.001 - 0.003	0.02
Gender, male	-0.03	-0.06 - 0.06	0.93
Smoking history	0.009	-0.03 - 0.04	0.61
Diabetes mellitus	-0.04	-0.12 - 0.05	0.41
Hypertension	-0.02	-0.10 - 0.05	0.53
Dyslipidemia	0.04	-0.05 - 0.13	0.41
Prior cardiovascular disease	-0.08	-0.16 - 0.007	0.07
Family history of coronary disease	0.02	-0.05 - 0.08	0.64
Arrival at day shift	-0.008	-0.08 - 0.07	0.82
Arrival at evening shift	-0.06	-0.17 - 0.05	0.27
Busyness at arrival	0.001	-0.001 - 0.002	0.76
Troponin result	-0.11	-0.18 - -0.03	0.004
Second troponin draw	0.16	0.09 - 0.23	<0.001	0.20	0.15 - 0.25	<0.001
Radiology request	0.06	-0.001 - 0.13	0.06	0.05	0.003 - 0.09	0.04
Hospital admission	0.02	-0.08 - 0.12	0.70

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