Article ; Online: Effects of an educational intervention for rational cardiac enzyme requisitions in critically ill patients: a pre-post intervention study.
2022 Volume 34, Issue 4
Abstract: Background: Although cardiac troponin is recommended as the biomarker of choice to evaluate myocardial injury, inappropriate low-value ordering practice is frequent, particularly routine ordering of creatine kinase-myocardial band (CK-MB) tests where ... ...
| Abstract | Background: Although cardiac troponin is recommended as the biomarker of choice to evaluate myocardial injury, inappropriate low-value ordering practice is frequent, particularly routine ordering of creatine kinase-myocardial band (CK-MB) tests where troponin is available. Objective: The aim of this study was to evaluate the impact of an educational intervention for rational request of cardiac biomarkers in the intensive care unit. Method: We conducted a quasi-experimental, pre-post implementation study of an educational program (expository-dialogue presentation and disclosure of a decision algorithm) for rational cardiac biomarker testing in adult critically ill patients. The study was divided into two 12-month periods: pre-intervention (September 2017-August 2018) and post-intervention (October 2018-September 2019). An interrupted time series with a segmented regression model was applied to analyze variation over time in CK-MB and troponin testing. Results: We included 4429 patients: 2181 patients in the pre-intervention period and 2248 patients in the post-intervention period. A reduction in the concomitance of CK-MB and troponin testing was observed (concomitance in 1415 tests in the pre-intervention period vs 348 tests in the post-intervention period). The interrupted time series analysis demonstrated a noticeable immediate reduction in the concomitance of CK-MB with troponin after the intervention (-0.13 tests per patient, P = 0.0016) but not in the secular trend for the concomitance. The proportion of patients with the acute coronary syndrome as a discharge diagnosis was not different between the pre- and post-intervention period. Conclusion: Our pre-post interventional study demonstrated a significant decrease in the concomitance of CK-MB and troponin tests. A rational high-value ordering practice of cardiac biomarkers is possible in critically ill patients and might be suitable for educational interventions. |
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| MeSH term(s) | Adult ; Humans ; Creatine Kinase, MB Form ; Critical Illness ; Troponin ; Acute Coronary Syndrome/diagnosis ; Biomarkers | |||||
| Chemical Substances | Creatine Kinase, MB Form (EC 2.7.3.2) ; Troponin ; Biomarkers | |||||
| Language | English | |||||
| Publishing date | 2022-10-25 | |||||
| Publishing country | England | |||||
| Document type | Journal Article | |||||
| ZDB-ID | 1194150-9 | |||||
| ISSN | 1464-3677 ; 1353-4505 | |||||
| ISSN (online) | 1464-3677 | |||||
| ISSN | 1353-4505 | |||||
| DOI | 10.1093/intqhc/mzac088 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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