Natriuretic peptide testing in EDs for managing acute dyspnea: a meta-analysis - 26/08/11

Doi : 10.1016/j.ajem.2010.02.026

Ludovic Trinquart, MSc ^a,^b,^{^{1
Conceived and designed the study.},}^{^{2
Responsible for the electronic search, data collection, and data analysis.},}^{^{3
Drafted the manuscript. All authors revised the manuscript for important intellectual content and approved the final version.}}, Patrick Ray, PhD, MD ^c,^d,^e,^{^{1
Conceived and designed the study.},}^{^{3
Drafted the manuscript. All authors revised the manuscript for important intellectual content and approved the final version.}}, Bruno Riou, PhD, MD ^c,^d,^e,^{^{1
Conceived and designed the study.},}^{^{3
Drafted the manuscript. All authors revised the manuscript for important intellectual content and approved the final version.}}, Antonio Teixeira, PhD, MD ^f,^g,^{^⁎,}^{^{1
Conceived and designed the study.},}^{^{2
Responsible for the electronic search, data collection, and data analysis.},}^{^{3
Drafted the manuscript. All authors revised the manuscript for important intellectual content and approved the final version.},}^{^{4
Is the guarantor.}}
^a Evidence-based Medicine Center, Paris, France
^b INSERM CIE 4, Paris, France
^c UPMC Univ Paris 06, Paris, France
^d Assistance Publique-Hôpitaux de Paris, Hôpital La Pitié-Salpêtrière, Service des Urgences, Paris, France
^e INSERM UMRS 956, Paris, France
^f Unité ER 10 Biologie et Physiologie des interactions neurorespiratoires et cardiopulmonaires, UPMC Univ Paris 06, Paris, France
^g Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Gériatrie, Paris, France

^⁎Corresponding author. Assistance Publique-Hôpitaux de Paris, Groupe Hospitalier Lariboisière-Fernand Widal, Service de Gériatrie, 200 rue du Faubourg Saint-Denis 75010 Paris, France. Tel.: +33 00331 40 05 42 90; fax: +33 00331 40 05 42 91.

Abstract

Purposes

The aim of the study was to assess the usefulness of systematic natriuretic peptide testing in the management of patients presenting with acute dyspnea to emergency departments (EDs).

Methods

We performed a systematic review and meta-analysis of randomized controlled trials assessing the usefulness of B-type natriuretic peptide (BNP) or its N-terminal fragment (NT-proBNP) in the management of patients presenting with dyspnea into ED. We searched Medline, Embase, and conference proceedings without restriction on neither language nor publication year. Selection of studies, data collection, and assessment of risk of bias were performed by 2 reviewers independently and in duplicate. Outcomes included hospital admission rate, time to discharge, and length of hospital stay, mortality and rehospitalization rates, and total direct medical costs. Combined risk ratios were estimated using fixed or random effects model. Duration and cost data were not combined.

Findings

Four randomized controlled trials, representing 2041 patients, were selected. In 4 trials, there was a tendency for hospital admission to be reduced in the intervention group (combined risk ratio, 0.95; 95% confidence interval, 0.89-1.01). Time to discharge was significantly reduced in 2 trials, whereas there was no significant reduction in hospital length of stay in 3 trials. There was no significant effect on in-hospital and 30-day mortality rates or rehospitalization rates (3 trials reporting each outcome). Two trials found significant reduction in direct costs.

Conclusions

The current evidence remains inconclusive on whether systematic natriuretic peptide testing is useful for the management of patients presenting to ED with acute dyspnea.

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Plan

Introduction

Background

Importance

Goals of this investigation

Materials and methods

Selection criteria and search strategy

Selection of studies, data collection, and synthesis

Results

Hospital and ICU admission

Time to discharge and hospital length of stay

In-hospital and 30-day mortality

30-day readmission

Final heart failure diagnosis

☆	Competing interests: All authors except Dr Patrick Ray (PR) declare that they have no competing interest. PR has received honoraria from bioMérieux.

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Vol 29 - N° 7

P. 757-767 - septembre 2011 Retour au numéro

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Natriuretic peptide testing in EDs for managing acute dyspnea: a meta-analysis - 26/08/11

Abstract

Purposes

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Conclusions

Plan

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