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Troponin Testing and Coronary Syndrome in Geriatric Patients With Nonspecific Complaints: Are We Overtesting?
Author(s) -
Wang Alfred Z.,
Schaffer Jason T.,
Holt Daniel B.,
Morgan Keaton L.,
Hunter Benton R.
Publication year - 2020
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13766
Subject(s) - medicine , troponin , acute coronary syndrome , emergency department , population , troponin t , cohort , pediatrics , cardiology , emergency medicine , myocardial infarction , environmental health , psychiatry
Background Elderly patients presenting to the emergency department ( ED ) with nonspecific complaints ( NSC s) often undergo troponin testing to assess for atypical acute coronary syndrome ( ACS ). However, the rate of ACS and utility of troponin testing in this population is unknown. We sought to determine the rate of ACS and diagnostic yield of troponin testing in elderly patients with NSC s. Methods We retrospectively identified all patients aged ≥ 65 years triaged in the ED with NSC s from January 1, 2017, to June 30, 2017. NSC s were defined a priori and included complaints such as weakness, dizziness, or fatigue. NSC s were verified in ED provider notes by trained abstractors blind to testing results. Exclusions were focal chief complaint in provider notes, fever, and no troponin ordered. ACS was strictly defined and independently adjudicated by two trained physician researchers blind to the study hypothesis. We calculated the proportion of patients with ACS within 30 days and the test characteristics of troponin to diagnose ACS . Results Screening identified 1,146 encounters, and 552 were excluded for fever or focal chief complaints in the provider notes. Of the remaining 594 patients, troponin was ordered in 412 (69%), comprising the study cohort. The mean (± SD ) age was 78.7 (±8.3) years, with 58% female and 75% admitted. Troponin elevation occurred in 81 patients (20%). ACS occurred in 5 of 412 (1.2%). Troponin was 100% sensitive (95% confidence interval [ CI ] = 48% to 100%) and 81% specific (95% CI = 77% to 85%) for ACS . Of patients with elevated troponin, 93.8% were false positives (no ACS ). All patients with troponin elevation were admitted, but only one underwent angiography and no patients received reperfusion therapy. Conclusions While consideration for ACS is prudent in selected elderly patients with NSC s, ACS was rare and no patients received reperfusion therapy. Given the false‐positive rate in our study, our results may not support routine troponin testing for ACS in this population.