What We Talk About When We Talk About Troponin: A Descriptive Study of Troponin Terms

Abstract

Objectives: Elevated serum troponin values, regardless of cause, are associated with increased short-term and long-term mortality. The objective of this study was to describe and quantify use of troponin-related terms in hospital discharge summaries. Study Design: Retrospective chart review. Methods: We included patients admitted to the medical service of three Rhode Island hospitals in 2018. Patients had to have two or more troponin measurements, including at least one elevated value, as well as a rise-and-fall pattern. We reviewed text from three sections in the discharge summary—the problem list, hospital course, and attending attestation—to identify terms referring to troponin. We double-coded 10% of the sample to assess inter-rater reliability. Troponin terms were grouped by whether they referenced an abnormal level, as well as by the etiology of the elevation. Descriptive statistics were used. Results: 257 patients were included; 66% of their discharge summaries had a troponin descriptor. We identified 19 unique troponin terms: three of these terms implied a normal troponin level (e.g., “flat troponin”), seven described an abnormal elevation without specifically referencing myocardial injury as the etiology (e.g., “troponin bump”), and the rest referenced ischemia or infarction (e.g., “NSTEMI”). Over one-third (34%) of the records had no troponin terms in the discharge summary, despite those patients having at least one abnormal troponin level during their hospitalization. Conclusions: We found that clinicians used a wide variety of terms to describe troponin elevations in their discharge summaries, including minimizing language and potentially conflicting terms; a third of discharge summaries omitted any mention of the abnormal troponin value. More precise language may facilitate appropriate evaluation and management of these higher risk patients after hospital discharge.