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    
Abstract/OtherAbstract:
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.
Authors:
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    
Affiliation:
Department of Cardiology, Charing Cross Hospital, London, UK. krajappan@hhnt.org
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MeSH Terms
Descriptor/Qualifier:
Biological Markers / blood
Chest Pain / diagnosis*
Coronary Disease / diagnosis*
Diagnosis, Differential
Humans
Predictive Value of Tests
Risk Assessment
Syndrome
Troponin I / blood*
Chemical
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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