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BNP testing in ED does not consistently affect clinical outcomes

Clinical Question:
Does B-type natriuretic peptide testing affect clinical outcomes in patients with acute dyspnea in the emergency department?

Bottom Line:
Overall, using B-type natriuretic peptide (BNP) testing in the emergency department does not affect clinical outcomes, such as admission rate or mortality. However, some individual studies showed a benefit, which may reflect different systems of care, since the 5 studies included in this analysis were conducted in 5 different countries. (LOE = 1a-)

Reference:
Lam LL, Cameron PA, Schneider HG, Abramson MJ, Müller C, Krum H. Meta-analysis: effect of B-type natriuretic peptide testing on clinical outcomes in patients with acute dyspnea in the emergency setting. Ann Intern Med 2010;153(11):728-735.  [PMID:21135296]

Study Design:
Meta-analysis (randomized controlled trials)

Funding:
Self-funded or unfunded

Setting:
Emergency department

Synopsis:
This meta-analysis combined the results of 5 randomized controlled studies, conducted in 5 different countries, that evaluated the clinical outcomes associated with BNP testing in patients presenting to emergency departments with acute dyspnea. Two researchers independently selected studies for inclusion and evaluated the quality of the selected studies. The authors did not report whether they evaluated for publication bias. The studies used different BNP tests and different emergency department protocols. The studies enrolled a total of 2513 patients and were of high quality. Using BNP to evaluate patients in the emergency department decreased admissions in 1 of the 5 studies but, overall, had no effect on hospital admission rates. Similarly, overall hospital mortality and 30-day or 60-day mortality were not significantly affected by the use of BNP testing. The results of individual studies varied by country, with studies in some countries showing a greater benefit, though, as often happens in research, some early studies showed benefit that was not seen when the study was replicated in other settings.

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