The Veracity of Troponin Test Requests for Patients Presenting to the Emergency Department with Chest Pain; a Clinical Audit.

Abstract

Introduction:Troponin test is one of the methods for diagnosing acute coronary syndrome, but the overuse and misuse of this test has increased the costs imposed on the health system and the patients. Objective:The present study was conducted to investigate the veracity of troponin test requests for patients presenting to an emergency department with chest pain and examine the effectiveness of training emergency medicine assistants in reducing unnecessary and inappropriate requests in emergency departments. Methods:This clinical audit was conducted in the emergency department of Imam Hossein Hospital, Tehran, Iran, in 2014. Sampling was carried out using the census method and all the cases presenting to the emergency department for whom a troponin test was requested by the emergency medical assistants were included in the research. First, the veracity of the current troponin test requests was assessed; then, training was given to the personnel, and the veracity of the troponin test requests was once again verified after the training was completed. The rate of veracious troponin requests for the patients was measured based on two factors, including the interval between the patients’ admission and the troponin test request, and the interval between the onset of pain and the troponin test request. The veracity of the troponin test request was compared before and after training using the Phi test and Cramer’s V test in IBM SPSS-21. Results:This study examined a total of 500 patients (250 before training and 250 after), who had a mean age of 57.65±18.15 years, including 51.6% men. Significant differences were observed between the mean time of the patients’ admission and the overall and post-training troponin test results (P=0.000), and also between the mean time of the onset of pain and the overall and post-training troponin test results (P=0.000). The number of positive troponin test results did not differ significantly between the patients in either of the two stages (P=0.39). Conclusion:Unnecessary troponin test requests reduced significantly after this clinical audit in the examined emergency department.