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Appropriate pathology ordering? Troponin testing within an Australian Emergency Department

Abstract

Background

Cardiac Troponin I and Troponin T are both very sensitive and specific, with the troponin pathology test recommended for the diagnosis of myocardial infarction. The diagnosis of myocardial infarction, in conjunction with electrocardiogram myocardial infarction, is based on a rise or fall of troponin with at least one value above the 99th percentile for the population. Troponin levels are regularly ordered within hospitals, especially in emergency medicine. It has been suggested that much of this testing is ordered despite the absence of clinical suspicion for acute coronary syndrome.

Aim

This study examined the appropriateness of troponin testing within one Australian teaching hospital.

Methods

A retrospective chart review was conducted of 111 randomly selected patients who received a troponin assay within the hospital’s Emergency Department. To determine appropriateness, the troponin test needed to reflect Australian clinical guidelines, and inform the ongoing management of the patient.

Results

Results demonstrate that the majority (76.6 %) of troponin testing was appropriate, with the remainder (23.4 %) deemed inappropriate due to not altering the ongoing patient management (n = 26), and not being informed by clinical guidelines (n = 26).

Conclusion

Troponin testing is important in the diagnosis of myocardial infarction, although should not be ordered routinely, or unnecessary. This study has determined that using clinical guidelines can promote rational ordering, and that testing should ultimately benefit patient management. Reducing inappropriate pathology test ordering is important to maximize productive clinical time, reduce false positives, maximize patient care, and to reduce financial waste.

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Acknowledgments

The researchers acknowledge Dr. Liz Forbat, Dr. Glen Verheul, Dr. John Ding and Dr. John Vinen for their valued assistance in concept design, data validation, processing, and formatting. The researchers also acknowledge the hospital’s library, specifically Lidia Hrvatin, for assistance in reviewing the literature.

Availability of data and materials The researchers would be happy to provide general de-identified research data, on a case-by-case basis. Data will not be made publically available due to hospital policy. Requests for data should be made in writing to the primary researcher. Approval to release data will be provided via the Hospital’s Research Ethics Committee.

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Correspondence to F. W. Gardiner.

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Conflict of interest

FG would like to disclose he is a current employee of the case hospital. There is no other conflict of interest to disclose

Ethical approval

This article was a retrospective chart review, and does not contain any studies with human participants or animals performed by any of the authors. This study was given approval by the Hospital Research Ethics Committee.

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Gardiner, F.W., Zhai, S. Appropriate pathology ordering? Troponin testing within an Australian Emergency Department. Ir J Med Sci 186, 213–218 (2017). https://doi.org/10.1007/s11845-016-1476-9

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  • DOI: https://doi.org/10.1007/s11845-016-1476-9

Keywords

  • Emergency medicine
  • Emergency Department
  • Troponin
  • Chest pain
  • Acute coronary syndrome