{"id":{"repo_id":"bournemouth","oai_identifier":"oai:eprints.bournemouth.ac.uk:24980"},"canonical_url":"https://search.dev.ndltd.org/etd/bournemouth/oai:eprints.bournemouth.ac.uk:24980","repository":{"repo_id":"bournemouth","name":"University of Bournemouth","base_url":"http://eprints.bournemouth.ac.uk/cgi/oai2"},"display":{"title":"A Novel accelerated diagnostic protocol to identify emergency department patients with chest pain who may be suitable for discharge after a single high-sensitivity troponin TRUST:Triage Rule-out Using high-sensitivity Troponin Chest Pain Study.","abstract":"Background Chest pain makes up a quarter of medical admissions in the United Kingdom. A diagnostic strategy that prevents unnecessary hospital admission in a large proportion of this patient group would have significant benefits for healthcare services by reducing hospital admission rates, ED overcrowding, duplication of staff time and resource use. A clinically applicable protocol that allows the discharge of a significant proportion of patients after a single blood draw at presentation to the emergency department remains an attractive yet elusive goal. Objective To establish whether a novel accelerated diagnostic protocol (ADP) for suspected acute coronary syndrome (ACS) could successfully identify low-risk patients suitable for discharge after a single high-sensitivity troponin T (hs-cTnT) taken at presentation to the Emergency Department (ED). Comparison of the diagnostic accuracy of this ADP with strategies utilising initial undetectable hs-cTnT was made. Methods This prospective observational study evaluated the ability of the Triage Rule-out Using high-Sensitivity Troponin (TRUST) ADP to identify low-risk patients with suspected ACS. The ADP incorporated a single presentation hs-cTnT of <14ng/L, a non-ischaemic electrocardiogram and a modified Goldman risk score. Diagnostic performance of the PhD Thesis. Dr Edward W. Carlton ADP was compared with the detection limit cut-offs of hs-cTnT (<5ng/L and <3ng/L). The primary endpoint was major adverse cardiac events (MACE) occurring within 30 days. Results 960 participants were recruited, mean age 58.0 years, 97 (10.1%) had MACE. The TRUST ADP classified 382 (39.8%) as low-risk with a sensitivity for identifying MACE of 99.0% (95%CI 93.7-99.9). Hs-cTnT detection limits (<5ng/L and <3ng/L) had a sensitivity of 96.8% (90.6-99.2) and 98.9% (93.8-99.9) respectively. The TRUST ADP identified more patients suitable for early discharge at 39.8% vs 29.3% (<5ng/L) and 7.9% (<3ng/L) (P<0.001) with a lower false-positive rate for MACE detection; specificity 44.1% (95%CI 43.6-44.3) vs 32.3% (95%CI 31.6-32.6) and 8.7% (95%CI 8.1-8.8) respectively. Conclusion The TRUST ADP, which incorporates structured risk-assessment and a single presentation hs-cTnT blood draw, has potential to allow early discharge in 40% of patients with suspected ACS and has greater clinical utility than undetectable hs-cTnT strategies.","abstract_html":"Background Chest pain makes up a quarter of medical admissions in the United Kingdom. A diagnostic strategy that prevents unnecessary hospital admission in a large proportion of this patient group would have significant benefits for healthcare services by reducing hospital admission rates, ED overcrowding, duplication of staff time and resource use. A clinically applicable protocol that allows the discharge of a significant proportion of patients after a single blood draw at presentation to the emergency department remains an attractive yet elusive goal. Objective To establish whether a novel accelerated diagnostic protocol (ADP) for suspected acute coronary syndrome (ACS) could successfully identify low-risk patients suitable for discharge after a single high-sensitivity troponin T (hs-cTnT) taken at presentation to the Emergency Department (ED). Comparison of the diagnostic accuracy of this ADP with strategies utilising initial undetectable hs-cTnT was made. Methods This prospective observational study evaluated the ability of the Triage Rule-out Using high-Sensitivity Troponin (TRUST) ADP to identify low-risk patients with suspected ACS. The ADP incorporated a single presentation hs-cTnT of &lt;14ng/L, a non-ischaemic electrocardiogram and a modified Goldman risk score. Diagnostic performance of the PhD Thesis. Dr Edward W. Carlton ADP was compared with the detection limit cut-offs of hs-cTnT (&lt;5ng/L and &lt;3ng/L). The primary endpoint was major adverse cardiac events (MACE) occurring within 30 days. Results 960 participants were recruited, mean age 58.0 years, 97 (10.1%) had MACE. The TRUST ADP classified 382 (39.8%) as low-risk with a sensitivity for identifying MACE of 99.0% (95%CI 93.7-99.9). Hs-cTnT detection limits (&lt;5ng/L and &lt;3ng/L) had a sensitivity of 96.8% (90.6-99.2) and 98.9% (93.8-99.9) respectively. The TRUST ADP identified more patients suitable for early discharge at 39.8% vs 29.3% (&lt;5ng/L) and 7.9% (&lt;3ng/L) (P&lt;0.001) with a lower false-positive rate for MACE detection; specificity 44.1% (95%CI 43.6-44.3) vs 32.3% (95%CI 31.6-32.6) and 8.7% (95%CI 8.1-8.8) respectively. Conclusion The TRUST ADP, which incorporates structured risk-assessment and a single presentation hs-cTnT blood draw, has potential to allow early discharge in 40% of patients with suspected ACS and has greater clinical utility than undetectable hs-cTnT strategies.","abstract_has_math":false,"creators":["Carlton, Edward Watts"],"institution":"Bournemouth University.","degree_name":null,"degree_level":"doctoral","degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":2016,"date_issued":"2016-07","date_published":"2016-07","updated_at":"2026-07-24T01:12:36Z","subjects":[],"languages":["en"],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":null,"outbound_label":null,"outbound_source":null},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:creator","label":"Author","values":["Carlton, Edward Watts"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date","label":"Dc Date","values":["2016-07-22"]},{"key":"dc:date.issued","label":"Date","values":["2016-07"]},{"key":"dc:publisher.department","label":"Dc Publisher Department","values":["School of Health and Social Care"]},{"key":"dc:publisher.institution","label":"Dc Publisher Institution","values":["Bournemouth University."]},{"key":"dc:relation.isreferencedby","label":"Dc Relation Isreferencedby","values":["https://eprints.bournemouth.ac.uk/24980/"]},{"key":"dc:type","label":"Dc Type","values":["Thesis"]},{"key":"dc:type.qualificationlevel","label":"Dc Type Qualificationlevel","values":["doctoral"]}]},{"id":"language_rights","label":"Language and Rights","entries":[{"key":"dc:language","label":"Dc Language","values":["en"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["https://eprints.bournemouth.ac.uk/24980/1/CARLTON%2C%20Edward%20W._Pd.D._2015%20-%20BURO.pdf"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["Background Chest pain makes up a quarter of medical admissions in the United Kingdom. A diagnostic strategy that prevents unnecessary hospital admission in a large proportion of this patient group would have significant benefits for healthcare services by reducing hospital admission rates, ED overcrowding, duplication of staff time and resource use. A clinically applicable protocol that allows the discharge of a significant proportion of patients after a single blood draw at presentation to the emergency department remains an attractive yet elusive goal. Objective To establish whether a novel accelerated diagnostic protocol (ADP) for suspected acute coronary syndrome (ACS) could successfully identify low-risk patients suitable for discharge after a single high-sensitivity troponin T (hs-cTnT) taken at presentation to the Emergency Department (ED). Comparison of the diagnostic accuracy of this ADP with strategies utilising initial undetectable hs-cTnT was made. Methods This prospective observational study evaluated the ability of the Triage Rule-out Using high-Sensitivity Troponin (TRUST) ADP to identify low-risk patients with suspected ACS. The ADP incorporated a single presentation hs-cTnT of <14ng/L, a non-ischaemic electrocardiogram and a modified Goldman risk score. Diagnostic performance of the PhD Thesis. Dr Edward W. Carlton ADP was compared with the detection limit cut-offs of hs-cTnT (<5ng/L and <3ng/L). The primary endpoint was major adverse cardiac events (MACE) occurring within 30 days. Results 960 participants were recruited, mean age 58.0 years, 97 (10.1%) had MACE. The TRUST ADP classified 382 (39.8%) as low-risk with a sensitivity for identifying MACE of 99.0% (95%CI 93.7-99.9). Hs-cTnT detection limits (<5ng/L and <3ng/L) had a sensitivity of 96.8% (90.6-99.2) and 98.9% (93.8-99.9) respectively. The TRUST ADP identified more patients suitable for early discharge at 39.8% vs 29.3% (<5ng/L) and 7.9% (<3ng/L) (P<0.001) with a lower false-positive rate for MACE detection; specificity 44.1% (95%CI 43.6-44.3) vs 32.3% (95%CI 31.6-32.6) and 8.7% (95%CI 8.1-8.8) respectively. Conclusion The TRUST ADP, which incorporates structured risk-assessment and a single presentation hs-cTnT blood draw, has potential to allow early discharge in 40% of patients with suspected ACS and has greater clinical utility than undetectable hs-cTnT strategies."]},{"key":"dc:format","label":"Dc Format","values":["application/pdf"]},{"key":"dc:title","label":"Title","values":["A Novel accelerated diagnostic protocol to identify emergency department patients with chest pain who may be suitable for discharge after a single high-sensitivity troponin TRUST:Triage Rule-out Using high-sensitivity Troponin Chest Pain Study."]}]}],"canonical_facts":{"dc:creator":["Carlton, Edward Watts"],"dc:date":["2016-07-22"],"dc:date.issued":["2016-07"],"dc:description.abstract":["Background Chest pain makes up a quarter of medical admissions in the United Kingdom. A diagnostic strategy that prevents unnecessary hospital admission in a large proportion of this patient group would have significant benefits for healthcare services by reducing hospital admission rates, ED overcrowding, duplication of staff time and resource use. A clinically applicable protocol that allows the discharge of a significant proportion of patients after a single blood draw at presentation to the emergency department remains an attractive yet elusive goal. Objective To establish whether a novel accelerated diagnostic protocol (ADP) for suspected acute coronary syndrome (ACS) could successfully identify low-risk patients suitable for discharge after a single high-sensitivity troponin T (hs-cTnT) taken at presentation to the Emergency Department (ED). Comparison of the diagnostic accuracy of this ADP with strategies utilising initial undetectable hs-cTnT was made. Methods This prospective observational study evaluated the ability of the Triage Rule-out Using high-Sensitivity Troponin (TRUST) ADP to identify low-risk patients with suspected ACS. The ADP incorporated a single presentation hs-cTnT of <14ng/L, a non-ischaemic electrocardiogram and a modified Goldman risk score. Diagnostic performance of the PhD Thesis. Dr Edward W. Carlton ADP was compared with the detection limit cut-offs of hs-cTnT (<5ng/L and <3ng/L). The primary endpoint was major adverse cardiac events (MACE) occurring within 30 days. Results 960 participants were recruited, mean age 58.0 years, 97 (10.1%) had MACE. The TRUST ADP classified 382 (39.8%) as low-risk with a sensitivity for identifying MACE of 99.0% (95%CI 93.7-99.9). Hs-cTnT detection limits (<5ng/L and <3ng/L) had a sensitivity of 96.8% (90.6-99.2) and 98.9% (93.8-99.9) respectively. The TRUST ADP identified more patients suitable for early discharge at 39.8% vs 29.3% (<5ng/L) and 7.9% (<3ng/L) (P<0.001) with a lower false-positive rate for MACE detection; specificity 44.1% (95%CI 43.6-44.3) vs 32.3% (95%CI 31.6-32.6) and 8.7% (95%CI 8.1-8.8) respectively. Conclusion The TRUST ADP, which incorporates structured risk-assessment and a single presentation hs-cTnT blood draw, has potential to allow early discharge in 40% of patients with suspected ACS and has greater clinical utility than undetectable hs-cTnT strategies."],"dc:format":["application/pdf"],"dc:identifier.uri":["https://eprints.bournemouth.ac.uk/24980/1/CARLTON%2C%20Edward%20W._Pd.D._2015%20-%20BURO.pdf"],"dc:language":["en"],"dc:publisher.department":["School of Health and Social Care"],"dc:publisher.institution":["Bournemouth University."],"dc:relation.isreferencedby":["https://eprints.bournemouth.ac.uk/24980/"],"dc:title":["A Novel accelerated diagnostic protocol to identify emergency department patients with chest pain who may be suitable for discharge after a single high-sensitivity troponin TRUST:Triage Rule-out Using high-sensitivity Troponin Chest Pain Study."],"dc:type":["Thesis"],"dc:type.qualificationlevel":["doctoral"]},"updated_at":"2026-07-24T01:12:36Z"}