%0 Journal Article
%T Biomarker Diagnostics in Acute Cardiac and Noncardiac Dyspnea: Is There a Role for Point-of-Care Testing?
%A Dirk Peetz
%J Conference Papers in Science
%D 2013
%R 10.1155/2013/891072
%X The use of biomarkers in acute chest pain and dyspnea is well established and point-of-care testing (POCT) is increasingly used in emergency departments and chest pain units for this purpose. However, few data give evidence that POCT has advantages for the patient or the medical process over central laboratory testing. Especially for troponin testing in patients with myocardial infarction, the newest guidelines define prerequisites on diagnostic test quality which most POC assays do not fulfill. Additionally, no data are available showing that POCT has relevant effect on a change of physician¡¯s diagnostic and therapeutic thinking compared to laboratory testing. Regarding patient outcomes and societal costs, central laboratory testing seems to be even superior to POCT. The main limit of currently available POC troponin assays is the higher limit of detection and higher imprecision compared to the new high sensitive laboratory assays. However, new upcoming POC technologies may perform comparable to today¡¯s laboratory analyzers. 1. Introduction Biomarkers are regularly used to guide diagnosis in patients with acute chest pain and acute dyspnea. In acute chest pain¡ªwith and without dyspnea¡ªthe use of troponins to diagnose acute coronary syndrome is well established, and clear guidelines are available [1]. The same is true for the use of D-dimer to exclude acute pulmonary embolism [2]. In other causes of dyspnea, natriuretic peptides can help to distinguish between a cardiac or pulmonary etiology [3]. In case of infections of the respiratory tract, C-reactive protein is a valuable laboratory marker and blood gas analysis is long-time established for monitoring of ventilation. Simple test strips or more complex analyzer systems are available for point-of-care testing (POCT) of all of these biomarkers, and many are regularly used in emergency departments, intensive care units, and smaller hospitals as solely available laboratory testing or in ambulatory care. However, there are few data given evidence if point-of-care testing of cardiac biomarkers has advantages for the patient or the medical process over central laboratory testing. Diagnostic test quality is defined by six test characteristics which can be used to assess if an assay performs better than another, in our case point-of-care testing versus central laboratory testing. These qualities are (1) technical quality of test information, (2) diagnostic accuracy, (3) change in the referring physician¡¯s diagnostic thinking, (4) change in the patient management plan, (5) change in patient outcomes, and (6)
%U http://www.hindawi.com/journals/cpis/2013/891072/