Related Experiment Video

Updated: Jun 3, 2025

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis
18:11

A Research Method For Detecting Transient Myocardial Ischemia In Patients With Suspected Acute Coronary Syndrome Using Continuous ST-segment Analysis

Published on: December 28, 2012

24.2K

Defensive Medicine in an Emergency Department: The Overuse of High-Sensitivity Cardiac Troponin I Testing

Mohammed Hani Sayyad1, Nir Levi2, Sharon Bruoha3

  • 1Emergency Department, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel.

Life (Basel, Switzerland)
|January 8, 2025
PubMed

Insights

Physicians frequently order high-sensitivity cardiac troponin I (hs-cTnI) tests in emergency departments due to medicolegal concerns, not just clinical need. This defensive medicine practice can lead to unnecessary tests and treatments.

Area of Science:

  • Emergency Medicine
  • Clinical Diagnostics
  • Medical Ethics

Background:

  • Cardiac troponin I testing is standard for suspected acute coronary syndrome.
  • Unindicated high-sensitivity cardiac troponin I (hs-cTnI) tests can cause unnecessary workups and management.
  • Investigating physician rationale for hs-cTnI use in the emergency department (ED) is crucial.

Purpose of the Study:

  • To investigate emergency department physicians' rationale for ordering high-sensitivity cardiac troponin I (hs-cTnI) tests.
  • To understand the influence of medicolegal concerns on hs-cTnI testing practices.

Main Methods:

  • Prospective study of 1890 patients undergoing hs-cTnI testing in an ED.
  • Classification of patients into cardiac and non-cardiac chief complaint groups.
  • Questionnaire survey of 47 ED physicians regarding hs-cTnI testing perspectives.

Main Results:

  • 97.9% of physicians cited diagnosing acute cardiac events as the purpose of hs-cTnI testing.
  • 38.3% ordered hs-cTnI tests in non-cardiac patients due to medicolegal concerns.
  • 53% reported working under medicolegal pressure, influencing test ordering.

Conclusions:

  • Defensive medicine is prevalent among ED physicians.
  • Routine hs-cTnI testing is partly driven by liability concerns.
  • Physician practices indicate a need to address defensive medicine in diagnostic testing.
Abstract

Keywords:
defensive medicineemergency departmenttroponin

More Related Videos

Impact of High-intensity Interval Exercise and Moderate-Intensity Continuous Exercise on the Cardiac Troponin T Level at an Early Stage of Training07:40

Impact of High-intensity Interval Exercise and Moderate-Intensity Continuous Exercise on the Cardiac Troponin T Level at an Early Stage of Training

Published on: October 10, 2019

7.2K
Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease06:16

Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease

Published on: August 9, 2024

353

Related Concept Videos

Blood Studies for Cardiovascular System I: Cardiac Biomarkers01:20

Blood Studies for Cardiovascular System I: Cardiac Biomarkers

Cardiac biomarkers are enzymes, proteins, and hormones released into the blood when cardiac cells are injured. They are powerful tools for triaging.
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
96
Errors occurring during blood pressure monitoring01:25

Errors occurring during blood pressure monitoring

Blood pressure monitoring is a crucial clinical procedure in diagnosing and managing various cardiovascular conditions. Despite its significance, the accuracy of blood pressure measurements can be compromised by multiple factors, potentially leading to either falsely high or low readings. These inaccuracies are critical as they can significantly impact patient care. So, it is vital to understand these challenges deeply and adopt strategic approaches to minimize errors.
Several factors...
591
Pulse rhythm01:30

Pulse rhythm

Pulse rhythm refers to the pattern of pulsations within specific intervals, offering valuable insights into the regularity or irregularity of the heart's beats as observed through the pattern of pulsation within specific intervals. A regular pulse exhibits a consistent heart rate with uniform waveforms and pulsation force, variations of which can be classified as normal, weak, or bounding.
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
758
Imaging Studies for Cardiovascular System V: CT01:28

Imaging Studies for Cardiovascular System V: CT

Cardiac computed tomography (CT) scanning is an advanced cardiac imaging technique that utilizes CT technology, with or without intravenous (IV) contrast, to produce accurate cross-sectional virtual slices of specific areas of the heart, coronary circulation, and major blood vessels such as the aorta, pulmonary veins, and arteries. The computer processes these slices to generate three-dimensional images. Multidetector CT (MDCT) is a rapid form of CT scanning that captures multiple slices...
1
Imbalances in Cardiac Output01:26

Imbalances in Cardiac Output

The heart's primary function is to pump blood throughout the body, maintaining a balance between blood sent out (cardiac output) and blood returning (venous return). If this balance is disrupted, it can result in congestive heart failure (CHF), a severe condition where the heart becomes an inefficient pump, leading to inadequate blood circulation.
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...
1.3K
Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers01:19

Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers

Cardiac biomarkers are critical in diagnosing, prognosing, and managing cardiovascular diseases. Routine measurement of specific biomarkers such as B-type natriuretic peptide (BNP), C-reactive protein (CRP), and homocysteine (Hcy) is common practice in clinical settings to evaluate heart function and predict cardiovascular events.
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
56