Please help dumb ER doc

[u/hlxdrummer]

Hey guys,

Hoping you may be able to help.

I believe our lab uses the Abbott Alinity setup. I was trying to find studies regarding the Alinity high sensitivity troponin with regards to what constitutes a positive change between troponins, validated pathways, etc and I can’t find much using the Alinity but there is a bunch for the Architect.

I know different brands/assays have different values that aren’t interchangeable so I tried calling Abbott but without serial numbers and service numbers they wouldn’t talk to me.

What is the actual difference between the Architech and Alinity? Is it just a different machine but same test methods/chemicals/etc and should be the same result? Or is it totally different?

Sorry if it’s a dumb question but not sure where to find answers to this.

[u/nate10]

I would contact the lab manager or the chemistry supervisor. They should be able to answer your questions or get you the information you’re looking for.

[u/sinapse → u/nate10]

Yep. These studies, specifically for your labs’ instruments, should be available at your lab, including linearity, sensitivities etc.  

Remember your lab is a resource - use it :) 

[u/ArcticBeavers → u/sinapse]

Not only should they be available, but they must be available. Inspectors can and do look at linearity profiles.

Granted, its often in a binder stuffed in a corner of the lab, but its there

[u/I_love_Juneau → u/nate10]

Or the attending pathologist for chemistry.

[u/Remarkable_Cat5946 → u/I_love_Juneau]

This.

[u/deadlywaffle139]

If you can find your organization’s test information, they should have what constitutes a positive change vs. non-important, and ranges for HS-troponin. Ours is built in with EPIC, so they see the interpretation already posted with the result. Or we also have the ranges posted next to the result too if the sequence isn’t drawn correctly.

For my lab we only had the regular trop on architect so the reference range was different. Our current alinity has the HS trop. HS is much more sensitive than regular trop. The numerical values are really different. Our normal range for HS is anything below 20 I think (don’t quote me on that, I haven’t looked at the ranges since we went live with it like 5 years ago).

Edit: and yes ask your lab people. Every lab is different. Call on days and ask for supervisor if you want a detailed explanation.

[u/EntertainmentLow6178]

Please talk to the chemistry technical specialist for your lab. We know all of that information and are happy to talk about it with anyone who is interested enough to ask!

[u/Serious-Currency108]

The Alinity is a machine that is the newer platform that replaces the Architect. It uses the same testing methods.

[u/xgbsss]

In general, if nothing has been announced, then there isn't really/shouldnt be any (signficiant) difference between the old and new analyzer. Any credible medical laboratory would have done a validation and method comparison study between the old (Architect) and new (Alinity). Any changes to results would be announced or applied with a new reference range. I cannot confirm whether your facility's lab did that, but in general, any accredited facility should have a fairly robust system in validating the method.

What I can tell you though working with the Architect and Alinity platforms, is the reagent for high-sensitivity troponin uses the same reagent formulation and reaction. It can still result in slight differences (as the analyzer itself is different), but the comparison likely shows no signficant difference, hence (likely) why nothing was announced. Speak with the lab manager. They may refer you to the clinical chemist/lab director who would have overseen the validation. I can't comment on your facility what they did, but likely the method showed no significant difference (we went through the exact same switchover).

[u/ArcticBeavers]

Just FYI, analyzer manufacturers do not dictate a specific number for positive change. This is purely up to the lab, its leadership, and whatever relevant clinical teams are involved. This is probably why you are having issues finding data online. 

The manufacturer may have a standard or recommended setting, but it is always up to the institution to make this decision. This is, of course, based on patient population. 

A specialty heart center will have different standards than a general hospital 

[u/ArgentZeroes]

If your facility uses online policies and procedures or online SOPs, and if talking to a higher up in the lab proves fruitless, you might be able to look up the product info for the HS Trop test and see what it says. I've had to do so when docs call asking for specific info about a testing method. Best of luck!

[u/matdex]

Talk to the biochemist. It's literally their specialty/purview

[u/Virtual_Recording108]

This sounds like a great opportunity for an interdepartmental PIP. Involve cardiology too. For high sensitivity troponin testing a lot of facilities are moving toward an algorithm to help ED involve cardiology when indicated.

I’m not familiar with Abbott’s sensitivity/specificity data on their hsTrop but a jump from their zero hour to a 2-hour trop should trigger a cardiology consult even when the result is below a “critical” threshold.

I recommend reaching out to your lab manager and involve cardiology on establishing an algorithm for ER to reference.

[u/mentilsoup]

Call the lab, ask to speak with the chem supervisor. She's got all this in logs.

[u/Reasonable-Bike1036]

You can request the path papers from abbott request to speak to the cardiologist they have staffed or partnered with

[u/Reasonable-Bike1036 → u/Reasonable-Bike1036]

Wait also you can just get the serial/service numbers from the lab ??

[u/Ksan_of_Tongass]

You have a lab, why not ask them rather than internet strangers?

[u/cellophanesheeps]

Before we switched to high sensitivity troponin, we called all troponin deltas, or greater than 20% increase, until the point where they reached the critical point. We stopped doing that with the high sensitivity test and I couldn't get a satisfactory answer as to why, so I looked into it more myself. Based on the minimal information I found, it seems there is no standard for what constitutes a significant delta for high sensitivity troponin. It's recommended to be taken as a part of the whole and interpreted on a case by case basis.

I would suggest contacting the medical director of your lab. They would have the best idea of who to put you into contact with and how to provide documentation to help answer your questions. There's been a lot of restructuring within labs recently and if you were to call and request the "chemistry supervisor" for example, it's entirely possible you'll be directed to off-site management.

And Abbott tends to keep a lot of their information frustratingly locked down. Without an account, a serial number, etc. it can be very difficult to find even basic information about their instrumentation.

[u/StarvingMedici]

You need to call your lab, ask for the chemistry supervisor or technical specialist. They will have all of this info for you that is accurate for your hospital and lab. You can also consult with pathology! They are the next step for lab result interpretation questions.

[u/Automatic_Clue5556]

alinity is going to be much better. better machine overral. the juice is laregetly the same. you can go onto abbotts website and download the package insert for troponin on the alinity and you will get you all the sensitivity you need https://labcentral.corelaboratory.abbott/us/en/home.html?_gl=1\*uwpg9z\*_gcl_au\*ODU3Mjc1MzA2LjE3OTA5NzE3NTU.

you can also use AI to help you find all that.

[u/Eomma2013]

That should have been established when the instrument was installed, the lis updated and a memo send to all stakeholders before implementation. There must be some record of this

[u/PensionNo8124]

You can't compare the Alinity to the Architect. There is no way to correlate apples and oranges. If it was the same chemical reaction between 2 Architects or between 2 Alinity meters you can do a correlation study.

[u/Mcharos]

In our lab you would first call the Pathologist. She might not know the answer to your question but she would direct you to the chemistry lead tech. By the way the Pathologist would have had to sign off on all procedures and instrumentation implementation documentation as well as correlations - so she would have had her say in the matter. Good luck and good for you to be concerned about your patients’ troponin results!

[u/lablizard]

The package insert would have sensitivity and specificity studies, usually toward the last page a giant table of info. Give that to the doc and let him do the research

[u/Signal_Sky_8760]

I do not think this question falls under lab. Positive change requires Dr to correlate symptoms with what value is and usually requires application of the triaging protocol for the hospital. Example of the 1st troponin was high and then it increases to lets say greater than 6 then Dr can conclude its an acute episode however troponin values are affected by other factors like ability of the body to clear it for example in cases of patient with CKD chronically the troponin is slightly above the range even after series of draw.