Abstract 279: Troponin Testing in the Emergency Setting: Analysis of Appropriateness

Abstract

Background: Troponin levels are routinely tested and trended in emergency departments even in the absence of clinical suspicion for Acute Coronary Syndrome. This can result in increased utilization of resources. We examined the rates at which troponin assays were drawn on admission to the medical service of our hospital and the appropriate use fo this assay. Methods: Consecutive patients admitted to the medical wards of our hospital over a one month period for which a Troponin level was obtained within 8 hours of arrival were prospectively identified. Baseline demographic and clinic characteristics and information regarding the admitting diagnosis were obtained through a detailed chart review. Cardiology testing or consults that were obtained soley for evaluation of an abnormal troponin were recorded. We defined an inappropriate troponin test (IT) as one that was drawn in the absence of a clear reason including, ischemic like symptoms (chest pain, epigastric pain, upper back pain, jaw pain or left shoulder/arm pain), unexplained shortness of breath, new ECG changes, syncope, arrhythmia or CHF. Results: Among 142 patients identified, 47 (33%) had IT. These patients were 61.9 ± 19.3 years of age (range 19-102 years), and 18 (38.3%) were female. Admitting diagnoses for those patients who had IT included the following: Altered mental status 8 (17%); Sepsis/Infection 8 (17%); Weakness 6 (12.8%); Other GI symptoms 5 (10.6%); GI Bleeding 2 (4.3%); Other miscellanous diagnosis 18 (38.3%). Table 1 depicts the characteristics of these patients. Conclusion: Significant number of patients admitted with non-cardiac diagnoses have Troponin assays drawn for unapparent reasons; This IT assay rarely results in the identification of a new cardiac diagnosis. In the long term, these IT can result in a significant and unnecessary increased utilization of hospital resources.