Interest and value of point of care test in pre-hospital setting

Abstract

Point-of care troponin (POCT) is and stay a real support for acute coronary syndrome diagnosis and pathway in pre-hospital setting. There is no indication for clear acute myocardial infarction. But pre-hospital troponin conserves a real positive predictive value to identify high risk patients with non sus ST acute coronary syndroms. Those high risk patients must be adressed to hospital with cathlab facilities. A troponin/copeptin combined measurement owns a great predictive negative value of 99.7% in non-STEMI ACS patients, but it is not yet available in POC test. POC D-dimer tests in patients with thromboembolic disease is neither validated in the prehospital setting nor is available in most EMSs. Its result does not modify patients’ treatment or orientation. The POC BNP (brain natriuretic peptide) tests may be used in pre-hospital setting to confirm or exclude heart failure; it may improve patients’ treatment and orientation. POC BNP is not useful in front of acute pulmonary edema or cardiogenic shock in pre-hospital setting. POC BNP could be associated with pre-hospital ultrasound to identify the origin of an acute dyspnea.