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- Title
Usage of troponin in the real world: a lesson for the introduction of biochemical assays.
- Authors
K. Rajappan; E. Murphy; V. Amber; F. Meakin; B. Muller; K.F. Fox; C.S.R. Baker
- Abstract
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.
- Subjects
MICROBIOLOGICAL assay; HEART diseases; PHYSICIANS; INTERNAL medicine
- Publication
QJM: An International Journal of Medicine, 2005, Vol 98, Issue 5, p337
- ISSN
1460-2725
- Publication type
Article
- DOI
10.1093/qjmed/hci052