Document Detail

Usage of troponin in the real world: a lesson for the introduction of biochemical assays.
MedLine Citation:
PMID:  15820972     Owner:  NLM     Status:  MEDLINE    
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.
K Rajappan; E Murphy; V Amber; F Meakin; B Muller; K F Fox; C S R Baker
Publication Detail:
Type:  Journal Article     Date:  2005-04-08
Journal Detail:
Title:  QJM : monthly journal of the Association of Physicians     Volume:  98     ISSN:  1460-2725     ISO Abbreviation:  QJM     Publication Date:  2005 May 
Date Detail:
Created Date:  2005-04-18     Completed Date:  2005-07-28     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9438285     Medline TA:  QJM     Country:  England    
Other Details:
Languages:  eng     Pagination:  337-42     Citation Subset:  IM    
Department of Cardiology, Charing Cross Hospital, London, UK.
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MeSH Terms
Biological Markers / blood
Chest Pain / diagnosis*
Coronary Disease / diagnosis*
Diagnosis, Differential
Predictive Value of Tests
Risk Assessment
Troponin I / blood*
Reg. No./Substance:
0/Biological Markers; 0/Troponin I

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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