Prehospital Triage of Patients With Severe Shortness of Breath Using Biomarkers

NCT ID: NCT02050282

Last Updated: 2016-05-27

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

712 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-02-28

Study Completion Date

2016-05-31

Brief Summary

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Breathlessness is a dangerous symptom. Preliminary data from national and regional Danish databases show, that patients with shortness of breath in the ambulance have a very high mortality. Breathlessness can be caused by many different conditions - but heart diseases and lung diseases are dominant. The mortality is especially high in patients with breathlessness caused by heart disease.

Distinguishing these different causes of breathlessness is a classical, often difficult, discipline in medicine. Visitation and guidance of treatment in patients with breathlessness in the prehospital setting relies on medical history and physical examination and as a consequence prehospital treatment for breathlessness is often non-specific. The use of heart-failure specific biomarkers may improve prehospital visitation and treatment of patients with breathlessness.

We hypothesize, that

1. Supplementing the routine examination by prehospital anesthesiologist with measurement of a biomarker for heart failure increases the proportion of patients with severe shortness of breath caused by heart disease triaged directly to department of cardiology
2. This strategy does not increase the proportion of patients with severe shortness of breath caused by non-heart disease triaged directly to department of cardiology

Detailed Description

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Measurement of the biomarker for heart failure N-terminal pro-Brain Natriuretic Peptide (NT-proBNP):

In patients randomized to the strategy with supplementary measurement of NT-proBNP, a blood sample will be drawn from the peripheral venous catheter that is routinely inserted. This will be analyzed point-of-care in the ambulance.

Interpretation of NT-proBNP:

Cut-off values based on bootstrap-validated optimal cut-points for heart failure on will be used.

Confirmatory ('rule in') cut point

\< 50 years: 450 pg/mL

50-75 years: 900 pg/mL

\> 75 years: 1800 pg/mL

Exclusionary ('rule out') cut point

All patients: 300 pg/mL

The emergency physicians will be thoroughly informed about these cut-points, but told not to triage to department of cardiology or other department strictly according to NT-proBNP, but according to clinical assessment AND NT-proBNP.

Conditions

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Dyspnea

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

DIAGNOSTIC

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Business as usual

Triage and treatment based on routine clinical assessment as usual

Group Type NO_INTERVENTION

No interventions assigned to this group

Supplementary NT-proBNP measurement

Triage and treatment based on routine clinical assessment supplemented with measurement of NT-proBNP

Group Type EXPERIMENTAL

Supplementary NT-proBNP measurement

Intervention Type OTHER

In patients randomized to the strategy with supplementary measurement of NT-proBNP, a blood sample will be drawn from the peripheral venous catheter that is routinely inserted and analyzed immediately using a COBAS H232 and Roche Diagnostics NT-proBNP assay.

Interventions

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Supplementary NT-proBNP measurement

In patients randomized to the strategy with supplementary measurement of NT-proBNP, a blood sample will be drawn from the peripheral venous catheter that is routinely inserted and analyzed immediately using a COBAS H232 and Roche Diagnostics NT-proBNP assay.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

All patients requiring dispatch of emergency physician because of severe dyspnea.

Severe dyspnea is defined by dyspnea plus at least ONE of the following

* Respiration frequency \> 20 or \< 8
* Saturation \< 96 without supplementary oxygen
* Heart rate \> 100 or \< 50
* Systolic blood pressure \< 100 or \> 200
* Difficulty talking
* Central or peripheral cyanosis
* Use of accessory muscles of respiration
* Glasgow coma scale score \< 15

AND because of the physical condition, the patient is not able to give informed consent
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Central Denmark Region

OTHER

Sponsor Role collaborator

Aarhus University Hospital

OTHER

Sponsor Role collaborator

University of Aarhus

OTHER

Sponsor Role lead

Responsible Party

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Morten Thingemann Bøtker

MD, PhD student

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Morten Thingemann Bøtker, MD

Role: PRINCIPAL_INVESTIGATOR

Central Denmark Region

Christian Juhl Terkelsen, MD, DmSc

Role: STUDY_DIRECTOR

Department of Cardiology B, Aarhus University Hospital, Skejby, Denmark

Hans Kirkegaard, Professor

Role: STUDY_CHAIR

Aarhus University Hospital

Erika Frischknecht Christensen, MD

Role: STUDY_CHAIR

Central Denmark Region

Thorbjørn Grøfte, MD, PhD

Role: STUDY_CHAIR

Central Denmark Region

Carsten Stengaard, MD, PhD

Role: STUDY_CHAIR

Department of Cardiology B, Aarhus University Hospital, Skejby, Denmark

Locations

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Critical Care Team Aarhus, Prehospital Emergency Medical Services

Aarhus, Central Jutland, Denmark

Site Status

Critical Care Team Grenaa, Prehospital Emergency Medical Services

Grenå, Central Jutland, Denmark

Site Status

Critical Care Team Herning, Prehospital Emergency Medical Services

Herning, Central Jutland, Denmark

Site Status

Critical Care Team Holstebro

Holstebro, Central Jutland, Denmark

Site Status

Critical Care Team Horsens, Prehospital Emergency Medical Services

Horsens, Central Jutland, Denmark

Site Status

Critical Care Team, Lemvig, Prehospital Emergency Medical Services

Lemvig, Central Jutland, Denmark

Site Status

Critical Care Team Randers, Prehospital Emergency Medical Services

Randers, Central Jutland, Denmark

Site Status

Critical Care Team Silkeborg, Prehospital Emergency Medical Services

Silkeborg, Central Jutland, Denmark

Site Status

Critical Care Team, Viborg, Prehospital Emergency Medical Services

Viborg, Central Jutland, Denmark

Site Status

Countries

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Denmark

References

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Botker MT, Jorgensen MT, Stengaard C, Seidenfaden SC, Tarpgaard M, Granfeldt A, Mortensen TO, Grofte T, Friesgaard KD, Maerkedahl R, Pedersen AB, Lundorff S, Hansen TM, Kirkegaard H, Christensen EF, Terkelsen CJ. Prehospital triage of patients suffering severe dyspnoea using N-terminal pro-brain natriuretic peptide, the PreBNP trial: a randomised controlled clinical trial. Eur Heart J Acute Cardiovasc Care. 2018 Jun;7(4):302-310. doi: 10.1177/2048872617709985. Epub 2017 May 11.

Reference Type DERIVED
PMID: 28492084 (View on PubMed)

Other Identifiers

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AU-PHAD01

Identifier Type: -

Identifier Source: org_study_id

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