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Presenting characteristics of patients undergoing cardiac troponin measurements in the emergency department

Published online by Cambridge University Press:  11 February 2015

Daniel A. Goodman ,
Peter A. Kavsak ,
Stephen A. Hill  and
Andrew Worster
Daniel A. Goodman*
Affiliation:
Division of Emergency Medicine, McMaster University Hamilton, ON, Canada
*
Correspondence to: Dr. Daniel Goodman, Division of Emergency Medicine, Hamilton General Hospital, McMaster Clinic, Room 251, 237 Barton Street East, Hamilton, ON L8L 2X2; Daniel.goodman@medportal.ca.

Abstract

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Introduction

Not all patients with suspected acute coronary syndrome (ACS) receiving cardiac troponin (cTn) testing present to the emergency department (ED) with cardiac chest pain. Since elderly patients (age ≥70) have increased morbidity and mortality associated with ACS, complaints other than cardiac chest pain may justify cTn testing. Our primary objective was to characterize the population of ED patients who receive cTn testing. The secondary objective was to determine if elderly patients underwent cTn testing for different presenting complaints than their younger counterparts.

Methods

We created an electronic database including Canadian Emergency Department Information Systems (CEDIS) presenting complaints, age, sex, disposition, and Canadian Triage Acuity Scale (CTAS) score, for patients who received cTn testing in three Canadian EDs during 2011. We analyzed the data for patient characteristics and sorted by age (<70 and ≥70) for further analysis.

Results

In the 15,824 included patients, the average age was 66 (51%<70; 51% female). The most common presenting complaints were cardiac chest pain (n=3,267) and shortness of breath (n=2,266). The elderly underwent cTn testing for significantly (p<0.0001) different complaints than their younger counterparts. They more commonly presented with generalized weakness (n=898), whereas younger patients more frequently had abdominal pain (n=576).

Conclusions

Cardiac chest pain and shortness of breath are presenting complaints in one-third of patients undergoing ED cTn testing. The majority of patients undergoing cTn testing did not have typical ACS symptoms. Half of all cTn testing in the ED is on the elderly, who present with different complaints than their younger counterparts.

Résumé

Introduction

Les patients souffrant d’un syndrome coronarien aigu (SCA) présumé et soumis à un dosage de la troponine cardiaque (TC) ne présentent pas tous une douleur thoracique cardiaque au service des urgences (SU). Comme les personnes âgées (âge ≥70 ans) connaissent une morbidité et une mortalité accrues, associées au SCA, la présence de symptômes différents de la douleur thoracique cardiaque peut justifier le dosage de la TC. L’étude avait pour objectif principal de caractériser la population soumise au dosage de la TC au SU. L’objectif secondaire visait à déterminer si les personnes âgées étaient soumises au dosage de la TC pour des motifs de consultation différents de ceux notés chez leurs homologues plus jeunes.

Méthode

Nous avons constitué une base de données comprenant les motifs de consultation selon les systèmes canadiens d’information des urgences, l’âge, le sexe, les suites à donner, et les résultats sur l’Échelle canadienne de triage et de gravité et concernant des patients soumis au dosage de la TC dans trois SU, au Canada, en 2011. Il y a eu analyse des données sur les caractéristiques des patients, puis répartition selon l’âge (<70 ans et ≥70) en vue d’une analyse approfondie.

Résultats

L’âge moyen, parmi les 15,824 patients retenus, était de 66 ans (<70 ans: 51%; femmes: 51%). Les motifs de consultation les plus fréquents é taient une douleur thoracique cardiaque (n=3,267) et l’essoufflement (n=2,266). Les personnes âgé es ont été soumises à un dosage de la TC pour des motifs de consultation sensiblement diffé rents (p<0.0001) de ceux notés chez leurs homologues plus jeunes. Le premier groupe pré sentait davantage une faiblesse généralisée (n=898), tandis que le second présentait plus souvent une douleur abdominale (n=576).

Conclusions

La douleur thoracique cardiaque et l’essoufflement sont les motifs de consultation qui justifient un dosage de la TC, au SU, chez un tiers des patients concernés. La majorité des patients soumis au dosage de la TC ne présentent pas les symptômes caractéristiques du SCA. La moitié des dosages de la TC effectués au SU l’est chez des personnes âgées, qui consultent pour des motifs différents de ceux observés chez leurs homologues plus jeunes.

Keywords

characteristicsdemographicselderlyemergency departmentmyocardial infarctiontroponin
Type
Original Research
Information
Canadian Journal of Emergency Medicine , Volume 17 , Issue 1 , January 2015 , pp. 62 - 66
Copyright
Copyright © Canadian Association of Emergency Physicians 2014 

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