In the ADAPT trial patients were enrolled between 2007 – 2011. Inclusion and exclusion criteria appear appropriate and relevant to our population with the exception one: the inability to contact the patient after follow-up. This exclusion could potentially apply to a large number of our patients. In addition the exclusion criteria included “staff considered recruitment to be inappropriate”, which could introduce bias into the study. Of those recruited not a single person was lost to follow-up. Of those deemed low-risk only one had a MACE, which on further review had a rising trop, making it very unlikely that this patient would have been discharged from our ED. The negative likelihood ratio for the ADAPT trial was 0.01, which is very strong. Additionally it was noted that the negative likelihood ratio for TIMI 0 and non-ischemic ECG was 0.07, also very strong. This data is similar that found in other studies evaluating TIMI and low-risk ECG. While this data needs to be reproduced in additional studies a 2 hours protocol using TIMI, ECG, and high sensitivity troponin may be safe option in low-risk patients.
Overall the article was well received. It was felt that although the study was done in Australia, as we are currently using high-sensitivity troponin in our ED, this study could be applied to our patient population. In general the study receives a thumbs-up.
