Hazards with ordering troponin in patients with low pretest probability of acute coronary syndrome.

Abstract

BACKGROUND:

In clinical practice, we progressively rely on biomarkers, without estimating the pretest probability. There is not enough support for the use of cardiac troponin (cTn) I in the management of noncardiac patients. We studied the rate at which this test was ordered, the prevalence of detection of a positive result in noncardiac patients, and the impact of this incidental finding on clinical management.

METHODOLOGY:

Patients admitted from December 2011 to 2013 to our community hospital with diagnosis of noncardiac disease who had positive cTn were included. Data collected included final diagnosis, patient disposition, cardiac monitoring, cardiology consult, and cardiac biomarker testing.

RESULTS:

Cardiac troponin I was ordered for 1700 patients in our emergency department. Seven hundred fifty patients had a positive cTn. Of the 750 patients, 412 had a positive cTn without any clinical suspicion of an acute coronary syndrome. An incidental finding of a positive cTn leads to ordering of cTn on average 4 times during admission, cardiac monitoring of 379 (91.99%) patients for at least 1 day, and a cardiac consultation for 268 (63.65%) of these patients. None of these patients was candidates for an invasive cardiac intervention. Seventy-eight (19.17%) patients were admitted to the cardiac care unit and subsequently transferred to the medical intensive care unit.

CONCLUSIONS:

A positive cTn in patients diagnosed with a nonacute coronary syndrome was associated with increased cardiac biomarker testing, telemetry monitoring, and cardiology consults. This study supports adherence to national guidelines for the use of cTn, to reduce hospital cost and resource utilization.

• Authors: Soheila Talebi, Rosa Maria Ferra, Sara Tedla, Alicia DeRobertis, Adrian C Garofoli, Ferdinand Visco, Gerald Pekler, Getaw Worku Hassen
• Journal: The American journal of emergency medicine (Am J Emerg Med) Vol. 33 Issue 9 Pg. 1258-60 (Sep 2015) ISSN: 1532-8171 [Electronic] United States
• PMID: 26119904 (Publication Type: Clinical Study, Journal Article)
• Copyright: Copyright © 2015 Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers
• Troponin I

Topics

• Acute Coronary Syndrome (blood, diagnosis, therapy)
• Adult
• Aged
• Aged, 80 and over
• Biomarkers (blood)
• Emergency Service, Hospital
• Female
• Humans
• Incidental Findings
• Male
• Middle Aged
• Predictive Value of Tests
• Reproducibility of Results
• Retrospective Studies
• Troponin I (blood)
• Young Adult