This article explores the potential benefits of point-of-care testing in the ED. Price and St. John provide a detailed description on how to approach four common aspects of point-of-care testing (POCT) in the ED, specifically, the challenges of adopting POCT, the impact of POCT on clinical decisions, the impact of...

Cardiac troponin T (cTnT) is the biomarker of choice for diagnosis of acute coronary syndromes (myocardial infarction (MI) and unstable angina). The cardiac muscle cell (myocyte) necrosis, consequent on ischemia that characterises MI, results in release of troponins from necrosed cardiac myocytes to blood and rising...

This short review aims to put the diagnostic options provided by state-of-the-art POCT  technology into perspective with the clinical challenges faced by physicians treating patients presenting with acute dyspnea.  Natriuretic peptides, hemoglobin, D-dimers and venous blood gases play a key role in the early...

Diagnosis of myocardial infarction in the absence of characteristic electrocardiographic (ECG) changes depends on measurement of circulating cardiac troponin (cTn); either cardiac troponin I (cTnI) or cardiac troponin T (cTnT).  By definition myocardial infarction is associated with increased serum cTnI and cTnT;...

Emergency Department (ED) overcrowding is becoming an increasingly international issue.  Although the problem is not only resolved by ED change management (but rather requires a system-wide solution recognizing the complex interdependencies of consumer expectations, human resources, information systems immaturity and...

Diagnosing heart failure (HF) in patients presenting in primary care is difficult. Clinical assessment of symptoms and signs has limited sensitivity and specificity. NT-proBNP determination has been proven to be useful and accurate for ruling out the diagnosis of systolic HF, and some have even proposed different...

Despite the pervasive measurement of cardiac troponin (cTn) for the diagnosis of myocardial infarction (AMI) and acute coronary syndromes (ACS), the continuous evolution of assays and guidelines for their application has created uncertainty among laboratorians and clinicians: criteria for the choice of assay and...

A new parameter called critical reference change value (CrRCV) to be applied for the interpretation of serial measurements of cardiac troponin I (cTnI) is introduced. To illustrate the practical utility of CrRCV a set of clinical examples based on two consecutive cTnI results are presented. Thus three cTnI changes...

Various guidelines and recommendations are available for the use of natriuretic peptides in the diagnosis of heart failure. As it is known that old age may lead to higher natriuretic peptide values in the absence of heart failure, it is relevant to decide whether to use age-dependent reference intervals for clinical...

Emergency departments (ED) are challenged by increasing patient visits, overcrowding and prolonged length of stay (LOS). The cause of these problems is multifactorial. Delays in the laboratory are often perceived as contributing to delays in care and increased LOS. Implementation of selected point-of-care tests in...