Emergency departments (EDs) face rising demand and resource constraints. Cost-effectiveness analyses (CEAs) can inform resource allocation, but patient-level CEAs in emergency care remain methodologically heterogeneous. This review aimed to identify and describe patient-level CEAs in emergency care between 2000 and 2025, appraise their methodological quality, and explore temporal trends and evidence gaps. This systematic review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. PubMed/MEDLINE, Web of Science, CENTRAL, and gray literature were searched for patient-level CEAs of clinical or organizational interventions across prehospital, ED, and postemergency settings. Data were synthesized narratively across key methodological domains. Methodological quality of the economic evaluations was assessed using the quality of health economic studies (QHES) instrument. Descriptive and exploratory analyses were performed. Forty-seven studies were identified, of which 96% were conducted in EDs. Infectious diseases and ED crowding were the most addressed topics, followed by cardiovascular conditions and trauma, although a broad range of issues was covered. Studies were mainly conducted in high-income countries and evaluated organizational or diagnostic interventions. Healthcare system or hospital perspectives and short time horizons predominated. QHES scores were moderate-to-high (mean: 80.0, SD: 9.2, range: 56–96), with substantial variability and only a weak exploratory temporal trend toward higher scores. Prehospital and postemergency settings were underrepresented. Patient-level CEAs in emergency medicine are increasing, with many studies achieving high QHES scores, but remain heterogeneous in scope and methods. This review highlights the range of interventions evaluated and the methodological features relevant to interpreting economic evidence in emergency care.
High-sensitivity cardiac troponin (hs-cTn) assays have significantly enhanced the diagnosis in patients suspected of acute coronary syndrome (ACS). New hs-cTn point-of-care (POC) devices (turnaround time <20 min) may significantly reduce time to diagnosis. We evaluated the diagnostic accuracy of four currently commercially available hs-cTn POC devices to assess their potential for clinical implementation at the emergency department (ED). We conducted a search in PubMed Central on 20 November, 2025. Studies were included if they investigated patients greater than or equal to 18 years presenting with chest pain suggestive of ACS and evaluated commercially available hs-cTn POC devices. Studies had to report diagnostic accuracy [sensitivity, specificity, negative predictive value (NPV), positive predictive value] for the diagnosis of acute myocardial infarction (AMI). Studies were assessed for risk of bias and applicability using the QUADAS-3 tool. We identified 436 articles. The 11 included studies consisted of both derivation and validation studies, including a total of 10 115 patients. The hs-cTn POC assays demonstrated the best diagnostic accuracy when applied as a single-test rule-out upon arrival at the ED, showing the following sensitivity and NPV: Atellica VTLi sensitivity 98.8–100% for troponin less than 4 ng/L (NPV: 99.8–100%) and 100% for troponin less than 7 ng/L (NPV 100%). Pathfast sensitivity 96.3–100% for troponin less than 3 ng/L (NPV: 98.1–100%). i-STAT sensitivity of 99.8% for troponin less than 5 ng/L (NPV: 100%). TriageTrue sensitivity of 100% for troponin less than 3 ng/L (NPV 100%). VTLi, Pathfast, and TriageTrue were also tested using the 99 th percentile with a 0 + 1/2/3 h troponin protocol. Reported sensitivities: VTLi 64.8–100%, Pathfast 87% for plasma and 83% for whole blood, and TriageTrue 79.8%. Hs-cTn POC assays are reliable for integration into the diagnostic pathways for patients presenting with chest pain at the ED, mainly when used for rapid rule-out of AMI in patients with very low troponin values upon arrival.
