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Effects of environmental conditions on point-of-care cardiac biomarker test performance during a simulated rescue: Implications for emergency and disaster response

Richard F. Louie, PhD, FACB, William J. Ferguson, BS, Corbin M. Curtis, BS, John H. Vy, BS, Chloe S. Tang, BS, Gerald J. Kost, MD, PhD, MS, FACB

Abstract


Objective: To characterize the effects of environmental stress on point-of-care (POC) cardiac biomarker testing during a simulated rescue.
Design: Multiplex test cassettes for cardiac troponin I (cTnI), brain natriuretic peptide (BNP), CKMB, myoglobin, and D-dimer were exposed to environmental stresses simulating a 24-hour rescue from Hawaii to the Marshall Islands and back. We used Tenney environmental chambers (T2RC and BTRC) to simulate flight conditions (20°C, 10 percent relative humidity) and ground conditions (22.3-33.9°C, 73-77 percent). We obtained paired measurements using stressed versus control (room temperature) cassettes at seven time points (T1-7 with T1,2,6,7 during flight and T3-5 on ground). We analyzed paired differences (stressed minus control) with Wilcoxon signed rank test. We assessed the impact on decision-making at clinical thresholds.
Results: cTnI results from stressed test cassettes (n = 10) at T4 (p < 0.05), T5 (p < 0.01), and T7 (p < 0.05) differed significantly from control, when testing samples with median cTnI concentration of 90 ng/L. During the ground rescue, 36.7 percent (11/30) of cTnI measurements from stressed cassettes generated significantly lowered results. At T5, 20 percent (2/10) of cTnI results were highly discrepant—stressed cassettes reported normal results, when control results were >100 ng/L. With sample median concentration of 108 pg/mL, BNP results from stressed test cassettes differed significantly from controls (p < 0.05).
Conclusion: Despite modest, short-term temperature elevation, environmental stresses led to erroneous results. False negative cTnI and BNP results potentially could miss acute myocardial infarction and congestive heart failure, confounded treatment, and increased mortality and morbidity. Therefore, rescuers should protect POC reagents from temperature extremes.


Keywords


austere environments, disaster preparedness, medical errors, Pacific Islands, and quality assurance

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References


Louie RF, Ferguson WJ, Sumner SL, et al.: Effects of dynamic temperature and humidity stresses on point-of-care glucose testing for disaster care. Disaster Med Public Health Prep. 2012; 6: 232-240.

Louie RF, Sumner SL, Belcher S, et al.: Thermal stress and point-of-care testing performance: Suitability of glucose test strips and blood gas cartridges for disaster response. Disaster Med Public Health Prep. 2009; 3: 13-17.

Ferguson WJ, Louie RF, Yu JN, et al.: Dynamic temperature and humidity profiles for assessing the suitability of point-of-care testing during emergencies and disasters. 2011 American Association for Clinical Chemistry Annual Meeting, Abstract D-20: A155. Available at http://www.aacc.org/events/annualmtgdirectory/Documents/AACC_11_Abstract-A149-A160.pdf. Accessed March 4, 2013.

Alere Triage® Profiler SOB Package Insert, 2011. Available at https://sdmctrlprod.biosite.com/mc/main/index.cfm?event_showFile&ID_BC1E5A8E04D2604D17&static_false&mcuid_ANONYMOUS&mcsid_mc. Accessed March 4, 2013.

Lee S-C, Poon C-S, Li X-D, et al.: Indoor air quality investigation on commercial aircraft. Indoor Air. 1999; 9: 180-187.

Thygesen K, Alpert JS, Jaffe AS, et al.: Third universal definition of myocardial infarction. Circulation. 2012; 126: 2020-2035.

Mills NL, Churchhouse AMD, Lee KK, et al.: Implementation of a sensitive troponin I assay and risk of recurrent myocardial infarction and death in patients with suspected acute coronary syndrome. JAMA. 2011; 305: 1210-1216.

Morrow DA, Rifai N, Tanasijevic MJ, et al.: Clinical efficacy of three assays for cardiac troponin I for risk stratification in acute coronary syndromes: A Thrombolysis In Myocardial Infarction (TIMI) 11B Substudy. Clin Chem. 2000; 46: 453-460.

Kost GJ, Sakaguchi A, Curtis C, et al.: Enhancing crisis standards of care using innovative point-of-care testing. Am J Disaster Med. 2011; 6: 351-368.

Gautam S, Menachem J, Srivastav SK, et al.: Effect of Hurricane Katrina on the incidence of acute coronary syndrome at a primary angioplasty center in New Orleans. Disaster Med Public Health Prep. 2009; 3: 144-150.

Greenough PG, Lappi MD, Hsu EB, et al.: Burden of disease and health status among Hurricane Katrina-displaced persons in shelters: A population-based cluster sample. Ann Emer Med. 2008; 51: 426-432.

Ogawa K, Tsuji I, Shiono K, et al.: Increased acute myocardial infarction mortality following the 1995 Great Hanshin-Awaji earthquake in Japan. Int J Epidemiol. 2000; 29: 449-455.

Steptoe A, Brydon L: Emotional triggering of cardiac events. Neurosci Biobehav Rev. 2009; 33: 63-70.

Suzuki S, Sakamoto S, Koide M, et al.: Hanshin-Awaji earthquake as a trigger for acute myocardial infarction. Am Heart J. 1997; 134(5 Pt 1): 974-977.

Kost GJ, Tran NK. Point-of-care testing and cardiac biomarkers: The standard of care and vision for chest pain centers. Cardiol Clinics. 2005; 23: 467-490.

Mahajan VS, Jarolim P: How to interpret elevated cardiac troponin levels. Circulation. 2011; 124: 2350-2354.

Rust MJ, Carlson NA, Nichols JH: A thermo-modulating container for transport and storage of glucose meters in a cold weather environment. Point Care. 2012; 11: 157-160.

Curtis CM, Louie RF, Vy JH, et al.: Innovations in point-of-care testing for enhanced United States disaster caches. Am J Disaster Med. 2013 (in press).




DOI: https://doi.org/10.5055/ajdm.2013.0126

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