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The PRIMA Study: Presentation ischaemia-modified albumin in the emergency department

Keating, Lisa; Benger, Jonathan; Beetham, R.; Bateman, S.; Veysey, S.; Kendall, J.; Pullinger, R.

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Authors

Lisa Keating

Jonathan Benger

R. Beetham

Sarah Bateman Sarah3.Bateman@uwe.ac.uk
Director of Learning & Teaching

S. Veysey

J. Kendall

R. Pullinger



Abstract

Objectives: To investigate the diagnostic accuracy of presentation ischaemia-modified albumin (IMA), in addition to cardiac troponin I (Tnl), as a strategy to rapidly ascribe low risk to patients with chest pain attending an emergency department, and to determine whether IMA has the potential to reduce transit time in emergency departments. Methods: A prospective observational study was carried out in two emergency departments (belonging to the John Radcliffe Hospital, Oxford, UK; and the Frenchay Hospital, Bristol, UK) of similar size. Consecutive adult patients presenting with features of possible ischaemic cardiac chest pain and a normal electrocardiogram were eligible. The index test (measurement of IMA and Tnl at presentation) and reference standard (delayed Tnl measurement, taken at least 8 h after pain onset) were applied to all recruited patients. All clinicians were blinded to the results of the index test. Assays were carried out in a single laboratory using standard techniques. Results: 399 patients were recruited; 277 patients had a result for both the index test and reference standard. The sensitivity was 97.6% (95% confidence interval (CI) 87.4 to 99.9), negative predictive value 97% (95% CI 84.2 to 99.9) and specificity 13.69/o (95% CI 9.5 to 18.7). Sensitivity analysis showed similar findings in three alternative scenarios. Receiver operating characteristic analysis indicated that a different "cut-off" value for IMA would not improve the properties of the test. The median potential time saved (n=268) was 6 h and 10 min. Conclusion: The diagnostic accuracy of presentation IMA in this study does not support its use as an effective risk stratification tool for patients with chest pain in the emergency department. The sensitivity is insufficiently high, with a small number of false negatives undermining the safety of the test. Frequent false positives produce a low specificity that limits the practical value of the test.

Citation

Keating, L., Benger, J., Beetham, R., Bateman, S., Veysey, S., Kendall, J., & Pullinger, R. (2006). The PRIMA Study: Presentation ischaemia-modified albumin in the emergency department. Emergency Medicine Journal, 23(10), 764-768. https://doi.org/10.1136/emj.2006.036269

Journal Article Type Article
Publication Date Oct 1, 2006
Deposit Date Jan 22, 2010
Publicly Available Date Mar 28, 2024
Journal Emergency Medicine Journal
Print ISSN 1472-0205
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 23
Issue 10
Pages 764-768
DOI https://doi.org/10.1136/emj.2006.036269
Keywords PRIMA, ischaemia-modified albumin, emergency department
Public URL https://uwe-repository.worktribe.com/output/1036142
Publisher URL http://dx.doi.org/10.1136/emj.2006.036269
Additional Information Additional Information : The industry funded prospective observational study reported here demonstrates that the test under study had limited clinical value. This work contributed to establishing Benger's research partnerships with emergency departments, leading to further successful funding bids concerning management of chest pain.