MBA 560 Healthcare Management

The purpose of the assignment is to provide a critical appraisal for a cohort study in order to identify the effectiveness of the evidence and its application in the clinical practice. The selected study for the assignment is Undetectable High-Sensitivity Cardiac Troponin T Level in the Emergency Department and Risk of Myocardial Infarction by Bandstein et al., (2014).

The cohort study conducted by Bandstein et al., (2014) has focused on a specific issue such as evaluation of undetectable (<5 ng/l) high-sensitivity cardiac troponin T level and electrocardiogram in ruling out myocardial infraction in the ED without the symptoms of ischemia. The cohort study is type of longitudinal study that recruit a group of people to share the experience of a specific event for a selected time period and cross section is performed at the intervals of time to address the research question (Sedgwick, 2014). In this study the researchers have focused to identify the effectiveness of hs-cTnT and ECG to rule out MI without the sign of ischemia, thus have recruited patients with chest pain and having at least one hs-cTnT as the cohort in order to address the research question. Hence it can be said that the selection of cohort study as the research method is appropriate for the study and the researchers have recruited the cohort in an effective manner. Exposure was measured accurately for example, patient having at least one hs-cTnT level were identified and serum creatinine level, undetectable hs-cTnT level such as level <5 ng/l in combination with myocardial ischemia on ECG with no changes in ST segment were measured which indicated that the study has measured the required subjective and objective measurements for expected outcomes. However, lack of identification of confounding factors such as sensitivity analysis has been found in the study. The study has represented the follow up of every subject and considered the hazard ratio related to all risk factors of mortality for the patient with MI in emergency department was calculated in an effective manner which indicated that the follow up was complete enough and the time period of 30 months is a long period to reveal the good or bad effect. The result of the study has indicated that the negative predictive value of MI for the patient with undetectable hs-cTnT level and no evidence of ischemia changes on ECG within a tome period of 30 months is 99.8% and the negative predictive value for the death rate of such patients is 100%, which has reflected that patients with chest pain having hs-cTnT and no symptoms of ischemia on ECG are less susceptible to MI and death thus they could be discharged from the ED directly. The study has recruited 14636 participants for 30 months in order to derive the result. Adequate statistical analysis was performed and precise result have been provided by the authors. The presentation of the result, statistical analysis, effective follow up and positive outcomes have increased the reliability of the result, however, the study lack the analysis of biasness which is an questionable factor of the reliability of the result. The study was performed in Sweden which is different from the population of Saudi Arabia that may create concern regarding the application of the result, however, the large sample size and satisfactory outcome of the study it may be applicable to the local population of Saudi Arabia. In addition the findings were supported by other studies for example study of Cullen, Than & Peacock, (2014) also indicated the similar fact.

References:

Bandstein, N., Ljung, R., Johansson, M., & Holzmann, M. (2014). Undetectable High-Sensitivity Cardiac Troponin T Level in the Emergency Department and Risk of Myocardial Infarction. Journal Of The American College Of Cardiology, 63(23), 2569-2578. doi: 10.1016/j.jacc.2014.03.017

Cullen, L., Than, M., & Peacock, W. F. (2014). Undetectable hs-cTnT in the emergency department and risk of myocardial infarction. Journal of the American College of Cardiology, 64(6), 632-633. https://doi.org/10.1016/j.jacc.2014.03.017

Sedgwick, P. (2014). Retrospective cohort studies: advantages and disadvantages. Bmj, 348, g1072. https://doi.org/10.1136/bmj.g1072