Interhospital variation in the RATPAC trial (Randomised Assessment of Treatment using Panel Assay of Cardiac markers)

Fitzgerald, Patrick; Goodacre, Steve; Fitzgerald, Peter; Bradburn, Mike; Hassan, Tajek; Coats, Tim; Gray, Alasdair; Humphrey, Julian; Kendall, Jason; Smith, Jason; Collinson, Paul

Abstract

Background: The RATPAC trial showed that using a point-of-care panel of CK-MB(mass), myoglobin and troponin at baseline and 90 min increased the proportion of patients successfully discharged home, leading to reduced median length of initial hospital stay. However, it did not change mean hospital stay and may have increased mean costs per patient. The aim of this study was to explore variation in outcome and costs between participating hospitals. Methods: RATPAC was a pragmatic multicentre randomised controlled trial (N=2243) and economic analysis comparing diagnostic assessment using the panel to standard care for patients with acute chest pain due to suspected myocardial infarction at six hospitals. The difference in the proportion of patients successfully discharged (primary outcome) and mean costs per patient between the participating hospitals was compared. Results: Point-of-care assessment led to a higher proportion of successful discharges in four hospitals, a lower proportion in one and was equivocal in another. The OR (95% CI) for the primary outcome varied from 0.12 (0.01 to 1.03) to 11.07 (6.23 to 19.66) with significant heterogeneity between the centres (p

• Journal Article Type: Article
• Publication Date: Mar 1, 2012
• Deposit Date: Jul 14, 2011
• Publicly Available Date: Dec 2, 2016
• Journal: Emergency Medicine Journal
• Print ISSN: 1472-0205
• Electronic ISSN: 1472-0213
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 29
• Issue: 3
• Pages: 233-238
• DOI: https://doi.org/10.1136/emj.2010.108522
• Keywords: interhospital variation, RATPAC, randomised assessment, treatment, panel assay, cardiac markers
• Public URL: https://uwe-repository.worktribe.com/output/967280
• Publisher URL: http://dx.doi.org/10.1136/emj.2010.108522
• Additional Information: Corporate Creators : On behalf of the RATPAC Research Team
• Contract Date: Dec 2, 2016