Troponin Testing in the Emergency Department: Real world experience

Abstract

abstract:Objectives: The aim of this study was to examine patterns of troponin testing in the emergency department of a large tertiary care hospital in Oman and to determine its effect on patient management, including length of hospital stay (LOS). Methods: This retrospective study analysed the medical records of all adult patients undergoing troponin testing in the emergency department of the Sultan Qaboos University Hospital, Muscat, Oman, during the month of July 2015. Patients who presented with an ST-elevation myocardial infarction were excluded. Results: A total of 4,845 patients attended the emergency department during the study period; of these, troponin tests were ordered for 588 patients. The majority of the patients had negative troponin test results (81.3%). Chest pain, palpitations and breathlessness were the most common presenting complaints for those with positive troponin results. However, 41.8% of patients did not have any cardiac symptoms. Individuals with positive troponin tests had a significantly longer LOS compared to those with negative tests (mean: three versus one day; P = 0.001). In total, only 28.2% of those with positive troponin test results had final diagnoses associated with a cardiac condition, such as heart failure, an acute coronary syndrome (ACS), atrial fibrillation or other types of arrhythmia. Conclusion: A positive troponin test was associated with increased LOS; however, only a small proportion of these patients had a final diagnosis associated with a cardiac condition. Guidelines should be provided to ensure that troponin testing is performed only in cases where an ACS is suspected.

Coronary artery calcium score: pivotal role as a predictor for detecting coronary artery disease in symptomatic patients

“…Negative hsTn does not completely rule out the cardiac cause of symptoms, nor does it merely classify them as low-risk patients. The positive hsTn test extends the duration of the hospital stay and only 28.2% of those have been diagnosed with a cardiac condition such as heart failure, ACS, atrial fibrillation or other type of arrhythmia [57]. The addition of CAC testing to hsTn improves the identification of low- to intermediate-risk individuals in whom further invasive tests might be deferred [58].…”

Latest Concepts in Endodontic and Periodontal Management of Diabetic Patients

“…Moreover, periodontitis has been shown to be the leading cause of increased tooth mobility and loss in adults [44]. Changes in immune responses (for instance, neutrophil function disorders), gingival microflora, collagen structure and metabolism, vascular structure, gingival crevicular fluid, and genetic background are some of the factors involved in the two-way relationship between diabetes and periodontitis [45][46][47] Controlling periodontitis can lead to an improvement in glycemic control by reducing inflammation and subsequently lowering insulin resistance. Antibody production in response to periodontal microorganisms and the presence of NK T lymphocytes, self-reactive B lymphocytes, positive acute-phase proteins, and autoantibodies induce an autoimmune state [48].…”

“…This sensory disturbance makes it difficult to maintain a balanced diet and weakens glycemic control [46,47,65]. Oral mucosal changes such as fissured tongue, geographic tongue, recurrent aphthous stomatitis, and some premalignant lesions such as oral lichen planus (OLP) are associated with diabetes [47,65,67].…”

“…Poor/delayed ulcer healing in soft and hard oral tissues is a well-known condition in diabetic patients with oral injuries [47,65]. According to some studies, delayed angiogenesis, impaired circulation, hypoxia, decreased innate immunity, decreased production of growth factors, and stress are among the factors affecting the delayed healing of oral ulcers in these patients [47,68].…”

Appropriateness of troponin testing in emergency department at a tertiary care hospital in Saudi Arabia

“…E mergency department (ED) is one of the busiest and most stressful departments for the healthcare providers and especially for physicians, as they have the responsibility of ruling in or ruling out potentially life-threatening and serious conditions such as acute coronary syndrome (ACS), myocardial infarction (MI) and aortic dissection or pulmonary embolism (PE). 1 Laboratory testing, in addition to clinical judgement, plays a crucial role in emergency decision-making due to its influence on clinical judgement, treatment, and intervention. 2 The skeletal and cardiac muscles contain proteins known as troponins.…”