BNP Testing and Clinical Outcomes
From Annals of Internal Medicine: At two Australian teaching hospital emergency departments, 612 consecutive patients who presented with acute severe shortness of breath were assigned through randomized numbers to receive BNP testing (n = 306) or no testing (n = 306). Clinicians and evaluators of study endpoints were not blinded as to treatment or no treatment. The main endpoints of the study were admission rates, length of hospitalization and emergency department medications. Secondary endpoints were mortality and readmission rates.
The groups did not differ significantly in hospital admission rates (85.6% for the BNP group versus 86.6% for the control group; length of admission.
"Measurement of BNP in all emergency department patients with severe shortness of breath had no apparent effects on clinical outcomes or use of health services," the study authors write. "The findings do not support routine use of BNP testing in all severely dyspneic patients in the emergency department."
The limitations of this study include severe dyspnea requiring hospitalization in most patients, suggesting lack of generalizability to patients with milder degrees of breathlessness; lack of stratification by clinician; 60% of patients with chronic obstructive pulmonary disease and lung disease causing right heart failure and pulmonary hypertension, which can elevate BNP.
From Ann Intern Med 2009; 150:365-71.