The impact of prehospital blood sampling on the emergency department process of patients with chest pain: a pragmatic non-randomized controlled trial

Johan L van Nieuwkerk; M Christien van der Linden; Rolf J Verheul; Merel van Loon-van Gaalen; Marije Janmaat; Naomi van der Linden

doi:10.5847/wjem.j.1920-8642.2023.054

The impact of prehospital blood sampling on the emergency department process of patients with chest pain: a pragmatic non-randomized controlled trial

World J Emerg Med. 2023;14(4):257-264. doi: 10.5847/wjem.j.1920-8642.2023.054.

Authors

Johan L van Nieuwkerk¹, M Christien van der Linden², Rolf J Verheul³, Merel van Loon-van Gaalen⁴, Marije Janmaat⁵, Naomi van der Linden⁶

Affiliations

¹ Emergency Department, Haaglanden Medical Centre & Emergency Medical Services Haaglanden, the Hague 2501 CB, the Netherlands.
² Research and Development, Haaglanden Medical Centre, the Hague 2501 CK, the Netherlands.
³ Laboratory Services, Haaglanden Medical Centre, the Hague 2501 CK, the Netherlands.
⁴ Emergency Department, Haaglanden Medical Centre, the Hague 2501 CK, the Netherlands.
⁵ Faculty of Health, University of Applied Sciences Leiden, Leiden 2300 AJ, the Netherlands.
⁶ Faculty of Technology, Policy and Management, Delft University of Technology, Delft 2628 BX, the Netherlands.

Abstract

Background: In patients with chest pain who arrive at the emergency department (ED) by ambulance, venous access is frequently established prehospital, and could be utilized to sample blood. Prehospital blood sampling may save time in the diagnostic process. In this study, the association of prehospital blood draw with blood sample arrival times, troponin turnaround times, and ED length of stay (LOS), number of blood sample mix-ups and blood sample quality were assessed.

Methods: The study was conducted from October 1, 2019 to February 29, 2020. In patients who were transported to the ED with acute chest pain with low suspicion for acute coronary syndrome (ACS), outcomes were compared between cases, in whom prehospital blood draw was performed, and controls, in whom blood was drawn at the ED. Regression analyses were used to assess the association of prehospital blood draw with the time intervals.

Results: Prehospital blood draw was performed in 100 patients. In 406 patients, blood draw was performed at the ED. Prehospital blood draw was independently associated with shorter blood sample arrival times, shorter troponin turnaround times and decreased LOS (P<0.001). No differences in the number of blood sample mix-ups and quality were observed (P>0.05).

Conclusion: For patients with acute chest pain with low suspicion for ACS, prehospital blood sampling is associated with shorter time intervals, while there were no significant differences between the two groups in the validity of the blood samples.

Keywords: Blood specimen collection; Crowding; Emergency medical services; Troponin.