High-Sensitivity Troponin T Testing Affects Patient Observation in Emergency Department

November 2, 2019

By Erik MacLaren

DENVER -- November 1, 2019 -- Implementation of high-sensitivity troponin T (hsTnT) assays in emergency departments (EDs) has reduced the proportion of patients placed on observation for acute coronary syndrome (ACS), according to a study presented here at the 2019 Annual Meeting of the American College of Emergency Physicians (ACEP).

In addition, the rates of hospital admission increased among patients who were placed under observation, indicating that hsTnT testing was beneficial for targeting ED resources to patients at greater risk of cardiac events.

Abigail McGrath, MD, Duke University, Durham, North Carolina, and colleagues wanted to determine whether the introduction of such testing in a large, urban, academic ED would affect rates of patients being placed in observation for ACS.

The investigators analysed aggregate administrative data from an average of 6550 patients per month who visited the ED from September 1, 2018, to February 28, 2019 -- a timeframe that included 2 months before and 3 months after the implementation of routine hsTnT testing at the department.

Before implementation of hsTnT testing, 0.68% of patients presenting at the ED were placed in OBS for ACS, whereas 0.28% of patients were placed in OBS after testing was implemented. This difference was determined to be significant (P

The proportion of patients in observation who were eventually admitted to the hospital increased from 16.3% pre-test implementation to 25.0% after implementation (P = .04).

Dr. McGrath said the results support the benefits of implementing routine hsTnT testing and also noted that more work needed to be done since these results reflect the experience of a single center. In particular, she identified the multi-step testing protocols introduced during this study may not be feasible to implement in all EDs. In addition, patient outcomes were not included in this study and would provide valuable additional data in future studies.

[Presentation title: Effect of High Sensitivity Troponin Implementation on Emergency Department Observation Unit Operations. Abstract 59]