Diapositive 1

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Presentation
PRESENTED BY Eric-Allen Perreault
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Symptoms Most Prevalent
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Symptoms Most Prevalent

• Chest Pain
• S.O.B./Dyspnea
• Diaphoresis
• Swelling
• Coughing
• Fatigue
• Hemoptysis

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Rapid Diagnosis for S.O.B. and C.P.

• Saves Lives!
• A rapid, multi-marker strategy is widely
  supported for AMI and CHF presenters
• Chest pain and dyspnea are frequent symptoms for
  patients presenting to the ED.
• Coronary artery disease is the leading cause of
  death in the US, PE is ranked 3rd.
• 10 of patients with PE die within 60 min
• Treatments are available for patients that are
  appropriately diagnosed

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Rapid Diagnosis for S.O.B. and C.P.

• ED Overcrowding!
• 5,669,000 ED visits/year for chest pain and
  related symptoms
• 2 reason for visiting ED
• 2,535,000 ED visits/year for shortness of breath
• 7 reason for visiting ED
• 1,551,000 ED visits/year for labored breathing
  (dyspnea)
• 15 reason for visiting ED
• Patients often have comorbities and unclear
  diagnosis

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Rapid Diagnosis for S.O.B. and C.P.

• Avoiding the Missed AMI Diagnosis!
• AMI related chest pain is the leading symptom
  associated with medical malpractice claims.
• S.O.B. is 2!
• Patients often have comorbities and unclear
  diagnosis
• Respiratory complaints are most common in
  patients seen alive in the ED who later die
  unexpectedly

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Rapid Diagnosis for S.O.B. and C.P.

• Improving the Bottom Line!
• ACC/AHA, NACB guidelines and case studies clearly
  recommend and define benefits of a rapid
  diagnostic strategy
• Used in conjunction with other clinical
  information, rapid measurement of B-type
  natriuretic peptide in the emergency department
  improved the evaluation and treatment of patients
  with acute dyspnea and thereby reduced the time
  to discharge and the total cost of treatment.
• Christian Mueller, M.D. Use of B-Type Natriuretic
  Peptide in the Evaluation and Management of Acute
  Dyspnea NEJM Feb 2004
• If an inexpensive test is available that
  eliminates a significant portion of the patients
  without DVT or PE, health care savings occur.
• Richard A. Marlar, PhD Advance/Laboratory 2003
• Our findings point to the fact that Triage
  Cardiac must be part of the basic equipment in
  the ED just as the ECG is.
• Dr. Jean Pierre Rifler, SMUR, Montbard

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Triage Profiler S.O.B.

• Symptom Panel for Shortness of Breath Consists
  of
• D-Dimer 100 ng/mL to 5000 ng/mL
• XR BNP 5.0 pg/mL to 5000 pg/mL
• Troponin I 0.05 ng/mL to 30 ng/mL
• CK-MB 1.0 ng/mL to 80 ng/mL
• Myoglobin 5.0 ng/mL to 500 ng/mL

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What Does Profiler S.O.B. Do?

• Deciphers the diagnostic dilemma of patients with
  dyspnea/Chest Pain
• Should be the first draw in patients with dyspnea
  (or suspicion of pulmonary embolism) with or
  without Chest Pain
• Panel will allow clinician to
• Aid in diagnosis of AMI
• Risk stratify ACS patients
• Aid in diagnosis of CHF
• Assess disease severity of CHF
• Aid in diagnosis of PE and DVT

5 5 on 1 !
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Value of the SOB Approach
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Marker Interpretation First Draw
BNP
D-Dimer
TnI
CK-MB / Myo
Rule-In ACS/MI
Positive
Rule-Out PE/DVT
Rule-Out CHF
Negative
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Triage ProfilER SOB
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• Indications
• Tests
• Patient

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Analytical Sensitivity

• The lowest concentration of each analyte that the
  assay can reliably detect
• This is most relevant for a test like TnI than
  for BNP or D-dimer.
• Any level of TnI may be considered abnormal
• BNP and D-dimer are present in healthy
  individuals
• As long as the cutoff is well above the limit of
  detection, the assay has sufficient sensitivity

D-dimer 100 ng/mL XR BNP 5 pg/mL Troponin
I 0.05 ng/mL CK-MB 1.0 ng/mL Myoglobin 5ng/mL
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Interfering Substances

• D-dimer is unaffected by other markers of
  coagulation

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Analytical Specificity

• As with the original assays on the panel, the
  D-dimer assay is able to measure D-dimer without
  interference by medications a patient may be
  taking.

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Precision

• Imprecision data for the other analytes on the
  panel are similar to that already reported

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Is Your Test an ELISA?

• (What is ELISA?)

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ELISA / EIA

• Enzyme-Linked Immunosorbent Assay
• Synonymous with Enzyme Immunoassay (EIA)
• 1st ELISAs were run in Microtiter plates (aka
  ELISA plates)
• Member of a class of immunoassays
• All involve capturing the analyte
• All involve measuring captured analyte using a
  form of signal generator
• ELISA uses an enzyme-labeled antibody or antigen
  to convert an invisible molecule into a
  visible molecule
• Triage is an FIA that uses a fluorescent-labeled
  antibody or antigen as the signal
• FIA can be just as sensitive as EIA (e.g., TnI)

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Summary/Key Messages

• The Triage Symptom Panel of Profiler S.O.B.
  provide additional tools an ED physician needs to
  answer the dyspnea and chest pain diagnostic
  dilemma
• The ability to rapidly rule out PE and rule in or
  out AMI and CHF promises improved patient care,
  operational and economic benefits
• The Triage Total Solution
• Clinicians and Administrators
• POC accounts