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.

1. Arhami-Dolatabadi A, Kashani P, Hatamabadi H, Kariman H, Baratloo A. Using risk factors to help in the diagnosis of acute myocardial infarction in patients with non-diagnostic electrocardiogram changes in emergency department. JEPT. 2015;1(1):3-6.
2. Safari S, Baratloo A, Hashemi B, Rahmati F, Forouzanfar MM, Motamedi M, et al. Comparison of different risk stratification systems in predicting short-term serious outcome of syncope patients. J Res Med Sci. 2016;21(1):57.
3. Safaie A. Management of Dysrhythmia in Emergency Department. Emergency. 2015;3(1):2.
4. Hossein-Nejad H, Afzalimoghaddam M, Seyed-Hoseini-Davarani S. The validity of cardiopulmonary resuscitation skills in the emergency department using video-assisted surveillance: an Iranian experience. Acta Med Iran. 2012;51(6):394-8.
5. Zafari S, Ghadrdoost B, Hanifi Z, Khaleghparast-Athari S. The effect of face-to-face education on knowledge, attitude, and believes of acute coronary syndrome patients about heart disease: an experimental study. Ir J Cardiovas Nurs. 2012;1(1):36-41.
6. Valadkhani S, Jalili M, Hesari E, Mirfazaelian H. Validation of the North American Chest Pain Rule in Prediction of Very Low-Risk Chest Pain; a Diagnostic Accuracy Study. Emergency. 2017;5(1):e11.
7. Nabatchian F, Einollahi N, Dashti N, Sarraf-Nejad A, Kazemi-Khaledi A. Biochemical markers Troponin I, Leptin and CK-MB in coronary artery diseases. J Qazvin Univ Med Sci. 2010;14(1):12-7.
8. Wu AH, Apple FS, Gibler WB, Jesse RL, Warshaw MM, Valdes R. National Academy of Clinical Biochemistry Standards of Laboratory Practice: recommendations for the use of cardiac markers in coronary artery diseases. Clin Chem. 1999;45(7):1104-21.
9. Antman E, Bassand J-P, Klein W, Ohman M, Sendon JLL, Rydén L, et al. Myocardial infarction redefined—a consensus document of the Joint European Society of Cardiology/American College of Cardiology committee for the redefinition of myocardial infarction: the Joint European Society of Cardiology/American College of Cardiology Committee. J Am Coll Cardiol. 2000;36(3):959-69.
10. Morrow DA, Cannon CP, Jesse RL, Newby LK, Ravkilde J, Storrow AB, et al. National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: clinical characteristics and utilization of biochemical markers in acute coronary syndromes. Clin Chem. 2007;53(4):552-74.
11. Meng QH, Zhu S, Booth C, Stevens L, Bertsch B, Qureshi M, et al. Impact of the cardiac troponin testing algorithm on excessive and inappropriate troponin test requests. Am J Clin Pathol. 2006;126(2):195-9.
12. Shams-Vahdati S, Vand-Rajavpour Z, Paknezhad S-P, Piri R, Moghaddasi-Ghezeljeh E, Mirabolfathi S, et al. Cost-effectiveness of cardiac biomarkers as screening test in acute chest pain. J Cardiovasc Thorac Res. 2014;6(1):29-33.
13. Jalili M, Hejripour Z, Honarmand A, Pourtabatabaei N. Validation of the Vancouver Chest Pain Rule: a prospective cohort study. Acad Emerg Med. 2012;19(7):837-42.
14. O’Connor RE, Al Ali AS, Brady WJ, Ghaemmaghami CA, Menon V, Welsford M, et al. Part 9: acute coronary syndromes. Circulation. 2015;132(18 suppl 2):S483-S500.
15. Roffi M, Patrono C, Collet J-P, Mueller C, Valgimigli M, Andreotti F, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267-315.
16. Doolub G, Hadley G, Dwight J. Troponin Testing in the Emergency Setting: How Good are we. J Clin Exp Cardiolog S. 2012;12:2.
17. Nallet O, Arbaoui S, Grenier A, Michaud P, Safrano G, Sergent J. 324 Troponin in Emergency Department: an overused test for patient screening without clinical suspicion of acute coronary syndrome? Arch Cardiovasc Dis. 2011;3(1):109.
18. Arslanian-Engoren C, Engoren M. Physiological and anatomical bases for sex differences in pain and nausea as presenting symptoms of acute coronary syndromes. Heart Lung. 2010;39(5):386-93.
19. Arslanian-Engoren C, Patel A, Fang J, Armstrong D, Kline-Rogers E, Duvernoy CS, et al. Symptoms of men and women presenting with acute coronary syndromes. Am J Cardiol. 2006;98(9):1177-81.
20. Larochelle MR, Knight AM, Pantle H, Riedel S, Trost JC. Reducing excess cardiac biomarker testing at an academic medical center. J Gen Intern Med. 2014;29(11):1468-74.
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IssueVol 1 No 1 (2017): Autumn (November) QRcode
SectionOriginal article
PMCIDPMC6548087
PMID31172056
Keywords
Chest pain Clinical audit Emergency department Internship and Residency Troponin
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1.
Sabzghabaei A, Shojaee M, Amiri M, Akhoundzadeh N, Safari S. The Veracity of Troponin Test Requests for Patients Presenting to the Emergency Department with Chest Pain; A Clinical Audit. Front Emerg Med. 2017;1(1):e4.

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