Key result
Routine clinical use of troponin I assays fell below expected standards, with 39% of requests lacking clinical indications and 84% of negative-cTnI patients with possible ACS hospitalized >4 days.
Why the study?
The introduction of troponin assays into widespread clinical use requires assessment of whether routine practice conforms to ideal standards for timing, indication, and patient management.
Does routine clinical use of troponin I conform to ideal standards for risk stratification in chest pain patients?
Observational (n=72)
Does routine clinical use of troponin I conform to ideal standards for risk stratification in chest pain patients?
Real-world use of troponin assays often falls short of ideal standards regarding request timing, clinical indication, turnaround time, and subsequent patient management.
Answers are grounded in this paper and cite their sources.
Troponin I requests and management often deviate from standards in routine care; leaves open whether targeted interventions improve adherence.
BACKGROUND: Studies have demonstrated economic and clinical effectiveness using troponin as a risk stratification tool in chest pain patients. Those with a positive result are investigated invasively, whilst those with a negative result and ECG are promptly mobilized, facilitating discharge. AIM: To determine whether our use of troponin I (cTnI) in routine clinical practice conforms to ideal standards. DESIGN: Audit study. METHODS: Data were collected from 93 laboratory request forms for cTnI measurement on 72 patients with matched available patient records. RESULTS: Eighty requests had no information regarding timing of blood sample in relation to the clinical event; 39% gave no clinical indication. Only 71% of results were available within 12 h. An admission diagnosis of acute coronary syndrome (ACS) was made in 25%. Fifteen had typical cardiac chest pain with a negative cTnI: 6 of these had an exercise treadmill test before discharge. Nine had a positive cTnI, but only two had coronary angiography. Of patients with negative cTnI and possible ACS, 84% were in hospital for >4 days. DISCUSSION: The introduction of troponin assays into widespread use requires careful assessment. cTnI requests and subsequent patient management remain below expected standards. Ideally, the laboratory should provide an accurate result within a reasonable time frame, while physicians need to request cTnI at a suitable time-point and use the result appropriately. Lessons from the introduction of cTnI measurement may be useful for the introduction of future new tests in other areas of cardiology and medicine.
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Rajappan et al. (2005) conducted an observational in Chest pain / suspected acute coronary syndrome (n=72). Troponin I (cTnI) measurement was evaluated on Conformity of cTnI use to ideal standards (timing, clinical indication, turnaround time, and subsequent management). Routine clinical use of troponin I assays fell below expected standards, with 39% of requests lacking clinical indications and 84% of negative-cTnI patients with possible ACS hospitalized >4 days.
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