Impact of serum troponin measurement on triage of chest pain in a district hospital.
OBJECTIVE
To evaluate the impact on the clinical service of incorporating cardiac troponin T (cTnT) measurement into the existing chest pain care pathway in our district general hospital.


METHODS
We randomised 200 consecutive patients admitted with acute chest pain, but without ST elevation on ECG, either to our existing chest pain care pathway (pathway 1) or to a new pathway incorporating semi-quantitative cTnT measurement (pathway 2).


RESULTS
In comparison with pathway 1, in pathway 2 there was a strong trend towards reduced length of stay (3.13 v 4.36 days, p=0.08), and reduced usage of low molecular weight heparin (LMWH) (4.59 v 5.45 doses per patient, p=0.05). The number of cardiac events at three months in care pathway 1 (14/92) and care pathway 2 (22/108) did not significantly differ, p=0.34. In patients with atypical chest pain, there was a tendency for cardiologists to discharge earlier (1.75 v 2.03 days, p=0.07) and use less LMWH (2.04 v 2.97 doses, p=0.06) than general physicians.


CONCLUSIONS
In this study, incorporation of cTnT measurement into a chest pain care pathway resulted in a strong trend towards reduced length of hospital stay and LMWH usage.
Conway
B
B
Mater Hospital Trust, Crumlin Road, Belfast BT14 6AB. BryanConway@ntlworld.com
O'Connor
J
J
McClements
B
B
D000789:Angina, Unstable / Q000097:blood / Q000175:diagnosis*; D002637:Chest Pain / Q000097:blood* / Q000209:etiology; D019091:Critical Pathways; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005500:Follow-Up Studies; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D011446:Prospective Studies; D020107:Troponin T / Q000097:blood*
D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D020107:Troponin T