%0 Journal Article
%T Randomised controlled trial of the Limit of Detection of Troponin and ECG Discharge (LoDED) strategy versus usual care in adult patients with chest pain attending the emergency department: study protocol
%A Adam Reuben
%A Edward Carlton
%A Hazel Taylor
%A Jason Kendall
%A Jason Smith
%A Jenny Ingram
%A Jonathan Richard Benger
%A Patricia Jane Vickery
%A Peter Beresford
%A Rebecca Kandiyali
%A Sarah Campbell
%A Shahid Aziz
%J -
%D 2018
%R 10.1136/bmjopen-2018-025339
%X Introduction Observational data suggest a single high-sensitivity troponin blood test taken at emergency department (ED) presentation could be used to rule out major adverse cardiac events (MACE) in 10%¨C60% of ED patients with chest pain. This is done using an ¡®undetectable¡¯ cut-off (the Limit of Detection: LoD). We combined the LoD cut-off with ECG findings to create the LoDED strategy. We aim to establish whether the LoDED strategy works under real-life conditions, when compared with existing strategies, in a way that is cost-effective and acceptable to patients.

Methods and analysis This is a parallel-group pragmatic randomised controlled trial across UK EDs. Adults presenting to ED with suspected cardiac chest pain will be randomised 1:1. Existing rule-out strategies in current use across study centres, using serial high-sensitivity troponin testing, will be compared with the LoDED strategy. The primary outcome is successful early discharge (discharge from hospital within 4£¿hours of arrival) without MACE occurring within 30 days. Secondary outcomes include initial length of hospital stay; comparative costs; patient satisfaction and acceptability to patients. To detect a 9% difference between the early discharge rates (assuming an 8% rate in the standard care group) with 90% power, 594 patients need to be recruited, assuming a 95% follow-up rate.

Ethics and dissemination The study has been approved by the Frenchay Research Ethics Committee (reference 18/SW/0038). Results will be published in an international peer-reviewed journal. Lay summaries will be made available to patients.

Trial registration number [ISRCTN86184521][1]; Pre-results.

 [1]: /external-ref?link_type=ISRCTN&access_num=ISRCTN8618452
%U https://bmjopen.bmj.com/content/8/10/e025339