Adoption of High-sensitivity Troponin Testing and Emergency Physician Ordering Behavior

Area of Science:

• Cardiology
• Emergency Medicine
• Clinical Diagnostics

Background:

• Emergency departments (ED) are transitioning from conventional troponin assays to high-sensitivity troponin (hs-cTn) tests.
• This study evaluates the impact of hs-cTn introduction on troponin test utilization by emergency physicians.

Purpose of the Study:

• To assess changes in troponin test ordering patterns before and after the implementation of high-sensitivity troponin testing in an emergency department.
• To identify trends in physician utilization of troponin assays in the ED setting.

Main Methods:

• A retrospective analysis of 9,477 emergency department encounters was conducted.
• The study compared the percentage of encounters where serum troponin tests were ordered before and after the adoption of high-sensitivity troponin assays.

Main Results:

• Troponin test ordering decreased after the introduction of high-sensitivity troponin testing (28.3% before vs. 22% after, P <.001).
• The reduction in troponin orders was more significant in admitted patients (10.9% decrease) compared to discharged patients (3.6% decrease).

Conclusions:

• The implementation of high-sensitivity troponin testing was associated with a significant decrease in overall troponin test utilization in the ED.
• Physicians may be adopting more selective ordering behaviors, potentially influenced by the lower specificity of high-sensitivity troponin assays.