The Impact of Excessive Use of Troponin Tests in the Emergency Department – Too Much of a Good Thing?

From Mediware:

Just as we have learned about blood transfusion overuse, so too we now know that overuse of lab tests can be costly and cause patient harm. Cardiac Troponins (cTn) are markers of myocardial necrosis, and because of their high cardiac-specificity, are the preferred biomarker for the diagnosis of myocardial infarction (MI). However, cTn can be elevated in a number of non-cardiac conditions and “false-positives” can lead to downstream cardiac tests such as noninvasive stress testing, echocardiography, and invasive procedures such as cardiac catheterization and percutaneous coronary intervention. Additionally, misutilization of cTn can be costly – sometimes leading to increased patient stay in the hospital.

The Scope and Justification of cTn Misutilization
Nationally, there is a lot of variation in cTn orders. One group of researchers retrospectively analyzed the nature of cTn requests over a period of one week.1 They specifically looked at indication and final diagnostic impact. In many cases, they found that cTn requests were made without any clinical justification. A separate study in the United Kingdom found that 40% of troponin requests were inappropriate. In addition, some of the patients were inappropriately started on an acute coronary syndrome protocol.2 Clinical guidelines recommend against using cTn more than three times in a 24-hour period. Nonetheless, a study at John Hopkins found that 20% of patients received the test more than three times in a 24-hour period!


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