Patients with supraventricular tachycardia commonly present to the ED. There is a lack of consensus regarding assessment of these patients. Our aim was to determine the utility of troponin and four other investigations (full blood examination, electrolyte levels, thyroid function tests and chest X-rays) commonly requested for these patients. MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (January 1992-March 2017) were searched for randomised controlled trials and observational studies (of sample size greater than 10). Our search strategy yielded no randomised controlled trials and seven observational studies with significant statistical heterogeneity among selected studies (I 87.3%, P < 0.001). Included studies investigated a total of 1155 patients. All studies reported on the utility of troponin testing in this patient population. The pooled proportion of patients investigated with troponin was 0.66 (95% confidence interval 0.44-0.88). The pooled proportion of positive troponin tests was 0.32 (95% confidence interval 0.23-0.41). Only one study reported on the utility of the remaining four investigations with abnormal results as follows: thyroid stimulating hormone 14%, haemoglobin 6%, white cell count 19% and chest X-ray 22%. Investigations are commonly requested for patients presenting with supraventricular tachycardia. Troponin testing is commonly performed with a high proportion of positive findings although these results did not appear to be associated with major adverse cardiac events. Heterogeneity among studies and low levels of evidence precluded conclusions on full blood examinations, electrolyte levels, thyroid testing and utility of chest X-rays in this patient population.

Patients with supraventricular tachycardia (SVT) commonly present to the emergency department (ED). Current guidelines [1,2] do not recommend routine pathology testing and a report on the topic has questioned their role. A systematic review concluded that troponin testing is commonly performed with a high proportion of positive fi ndings, but these results were not associated with major adverse cardiac events. [3] The conclusions of this review were limited by paucity of data and heterogeneity among studies. Unnecessary and/or inappropriate investigations in the ED have been associated with adverse effects. False-positive results or incidental findings may lead to unnecessary investigation, at the risk of the true pathology being ignored. It is also important with respect to utilisation of resources, particularly in Australia where costs to the health care system are substantially borne by the taxpayer. [4] Evidence-based implementation of protocols for investigations, education program for medical staff and audit/feedback processes have been previously associated with safe and efficient diagnostic practices. [5] Among patients presenting to the ED with SVT, we aimed to describe adjunct investigations and assess whether the results of such investigations influenced management in the ED.