Tuesday, March 13, 2018

BNP in the ED

First10EM - By Justin Morgenstern - March 13, 2018
"In the most recent episode of Emergency Medicine Cases Journal Jam, Rory, Anton, and I cover the evidence for (for against) using BNP in the emergency department. These are my notes...
Looking at observational data, BNP and NT-proBNP both appear to have a good sensitivities for CHF, but only moderate to poor specificities. There are a number of RCTs looking at BNP use in the emergency department setting. Two studies demonstrated a decrease in hospital length of stay and total costs, but 4 other studies showed no difference. Two studies looked at ED length of stay, 1 demonstrating a statistical but clinically insignificant difference and the other showing no difference. None of the studies demonstrated a change in ED treatment, mortality, or hospital readmission. There are a large number of problems with these studies, including the lack of a clear gold standard for CHF, a lack of blinding, incorporation bias, and spectrum bias. These problems are discussed further in the discussion section. I have never worked in an emergency department where BNP testing has been available, and after reviewing this literature I think that is probably a good thing. It is easy to get excited about tests with high sensitivities, but the use of diagnostic tests is complex and fraught with unintended consequences. I think the best evidence to date suggests that BNP testing does not provide any patient important benefit to emergency department patients."