Premium
Rapid and safe discharge from the emergency department: A single troponin to exclude acute myocardial infarction
Author(s) -
Brichko Lisa,
Schneider Hans G,
Chan William,
Seah Jarrel,
Smit De Villiers,
Dart Anthony,
Stevens Jeremy P,
Mitra Biswadev
Publication year - 2018
Publication title -
emergency medicine australasia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.602
H-Index - 52
eISSN - 1742-6723
pISSN - 1742-6731
DOI - 10.1111/1742-6723.12919
Subject(s) - medicine , troponin i , myocardial infarction , troponin , emergency department , retrospective cohort study , emergency medicine , cardiology , psychiatry
Abstract Objective To determine variables that could facilitate safe discharge from the ED following a single high‐sensitivity troponin I (HsTnI) result to exclude acute myocardial infarction (AMI). Methods A retrospective cohort study was performed at a tertiary hospital of all patients that had serial HsTnI performed within 12 h of arrival to the ED over a 3 year period. The primary exposure variable of interest was a very low troponin initial result (HsTnI <5 ng/L). Medical record review and risk stratification score calculations were undertaken for all patients with the exposure variable of interest and an abnormal second troponin measurement (HsTnI ≥16 ng/L in women and HsTnI ≥26 ng/L in men). Results There were 11 970 patients who presented between 1 July 2013 and 30 June 2016 that had serial HsTnI measurements performed. Of these, 4172 (34.9%) patients had an initial HsTnI measurement <5 ng/L. Of the patients with an initial HsTnI <5 ng/L that met inclusion criteria, 56 (1.3%) had a second troponin result above the 99th percentile and 32 (0.8%) cases of non‐ST elevation myocardial infarction were diagnosed as well as 15 (0.4%) cases of ST elevation myocardial infarction. There were 44 (93.6%) of all AMI cases that met criteria for high‐risk presentations under the National Heart Foundation of Australia guidelines. The negative predictive value of an initial HsTnI <5 ng/L to exclude AMI was 98.9% (95% confidence interval 98.5–99.1). Conclusions This supports the utilisation of a rapid rule out strategy to exclude AMI for patients that have an initial HsTnI measurement <5 ng/L in conjunction with a robust risk assessment.