Prehospital triage of patients suffering severe dyspnoea using N-terminal pro-brain natriuretic peptide, the PreBNP trial: a randomised controlled clinical trial

TY - JOUR

T1 - Prehospital triage of patients suffering severe dyspnoea using N-terminal pro-brain natriuretic peptide, the PreBNP trial

T2 - a randomised controlled clinical trial

AU - Bøtker, Morten T

AU - Tarpgaard Jørgensen, Maren

AU - Stengaard, Carsten

AU - Seidenfaden, Sophie-Charlott

AU - Tarpgaard, Mona

AU - Granfeldt, Asger

AU - Mortensen, Tanja Ø

AU - Grøfte, Thorbjørn

AU - Friesgaard, Kristian D

AU - Maerkedahl, Rikke

AU - Pedersen, Anette B

AU - Lundorff, Simon

AU - Hansen, Troels Martin

AU - Kirkegaard, Hans

AU - Christensen, Erika F

AU - Terkelsen, Christian J

PY - 2018/6

Y1 - 2018/6

N2 - PURPOSE: The purpose of this study was to examine whether the addition of brain natriuretic peptide measurement to the routine diagnostic work-up by prehospital critical care team physicians improves triage in patients with severe dyspnoea.METHODS: Prehospital critical care team physicians randomly assigned patients older than 18 years with severe dyspnoea to routine diagnostic work-up or diagnostic work-up with incorporated point-of-care N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement. The primary endpoint was the proportion of patients with dyspnoea of primary cardiac origin triaged directly to a department of cardiology.RESULTS: A total of 747 patients were randomly assigned and 711 patients consented to participate, 350 were randomly assigned to the NT-proBNP group and 361 to the routine work-up group. NT-proBNP was measured in 90% (315/350) of patients in the NT-proBNP group and in 19% (70/361) of patients in the routine work-up group. There was no difference in the proportion of patients with dyspnoea of primary cardiac origin triaged directly to a department of cardiology between the NT-proBNP group and the routine work-up group (75% vs. 69%, P=0.22) in the intention-to-treat analysis. Sensitivity analysis according to the de facto diagnostics performed showed results consistent with this. No differences in hospital length of stay, intensive care unit admission rates or mortality between the NT-proBNP group and the routine work-up group were observed.CONCLUSION: Routine supplementary point-of-care measurement of NT-proBNP in patients with severe dyspnoea did not improve triage of patients with dyspnoea primarily caused by heart disease. ClinicalTrials.gov identifier NCT02050282.

AB - PURPOSE: The purpose of this study was to examine whether the addition of brain natriuretic peptide measurement to the routine diagnostic work-up by prehospital critical care team physicians improves triage in patients with severe dyspnoea.METHODS: Prehospital critical care team physicians randomly assigned patients older than 18 years with severe dyspnoea to routine diagnostic work-up or diagnostic work-up with incorporated point-of-care N-terminal pro-brain natriuretic peptide (NT-proBNP) measurement. The primary endpoint was the proportion of patients with dyspnoea of primary cardiac origin triaged directly to a department of cardiology.RESULTS: A total of 747 patients were randomly assigned and 711 patients consented to participate, 350 were randomly assigned to the NT-proBNP group and 361 to the routine work-up group. NT-proBNP was measured in 90% (315/350) of patients in the NT-proBNP group and in 19% (70/361) of patients in the routine work-up group. There was no difference in the proportion of patients with dyspnoea of primary cardiac origin triaged directly to a department of cardiology between the NT-proBNP group and the routine work-up group (75% vs. 69%, P=0.22) in the intention-to-treat analysis. Sensitivity analysis according to the de facto diagnostics performed showed results consistent with this. No differences in hospital length of stay, intensive care unit admission rates or mortality between the NT-proBNP group and the routine work-up group were observed.CONCLUSION: Routine supplementary point-of-care measurement of NT-proBNP in patients with severe dyspnoea did not improve triage of patients with dyspnoea primarily caused by heart disease. ClinicalTrials.gov identifier NCT02050282.

KW - Journal Article

KW - emergency medical services

KW - heart failure

KW - Dyspnoea

KW - decision-making

KW - brain natriuretic peptide

KW - randomised controlled trial

KW - Severity of Illness Index

KW - Single-Blind Method

KW - Heart Diseases/blood

KW - Humans

KW - Male

KW - Dyspnea/blood

KW - Triage/methods

KW - Emergency Medical Services/methods

KW - Point-of-Care Systems

KW - Aged, 80 and over

KW - Biomarkers/blood

KW - Female

KW - Aged

KW - Peptide Fragments/blood

KW - Retrospective Studies

KW - Natriuretic Peptide, Brain/blood

U2 - 10.1177/2048872617709985

DO - 10.1177/2048872617709985

M3 - Journal article

C2 - 28492084

SN - 2048-8726

VL - 7

SP - 302

EP - 310

JO - European Heart Journal: Acute Cardiovascular Care

JF - European Heart Journal: Acute Cardiovascular Care

IS - 4

ER -