The diagnostic value of troponin T testing in the community setting.
BACKGROUND
Many patients presenting with chest pain to their family physician are referred to the emergency room, in part, due to lack of accurate objective diagnostic tools. This study aimed to assess the diagnostic value of bedside troponin T kit testing in patients presenting with chest pain to their family physician.


METHODS
Prospective, multi-center study.


METHODS
Consecutive subjects with chest pain were recruited from 44 community clinics in Jerusalem. Following clinical assessment by the family physician, qualitative troponin kit testing was performed. Patients with a negative clinical assessment and negative troponin kit were sent home and all others were referred to the emergency room. The final diagnosis at the time of hospital discharge was recorded and telephone follow up was performed after 60 days. Positive predictive value, negative predictive value, sensitivity and specificity of troponin kit for myocardial infarction diagnosis and of family physician for hospitalization, were assessed.


RESULTS
Of 392 patients enrolled, 349 (89%) were included in the final analysis. The prevalence of myocardial infarction was 1.7%. The positive and negative predictive values of the troponin kit for myocardial infarction diagnosis were 100% and 99.7%, respectively. The positive and negative predictive values of the family physician's assessment to predict hospitalization were 41.4% and 94.1%, respectively.


CONCLUSIONS
Troponin kit testing is an important tool to assist the family physician in the assessment of patients with chest pain in the community setting. Troponin kit testing may identify otherwise undiagnosed cases of myocardial infarctions, and reduce unnecessary referrals to the emergency room.
Planer
David
D
Department of Internal Medicine, Hadassah-Hebrew University Medical Center, Mount Scopus Campus, POB 24035, Jerusalem, Israel. dplaner@md.huji.ac.il
Leibowitz
David
D
Paltiel
Ora
O
Boukhobza
Rina
R
Lotan
Chaim
C
Weiss
Teddy A
TA
D000553:Ambulatory Care; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000175:diagnosis*; D005194:Family Practice; D005260:Female; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D011446:Prospective Studies; D011933:Reagent Kits, Diagnostic; D012017:Referral and Consultation; D012680:Sensitivity and Specificity; D020107:Troponin T / Q000097:blood*
D015415:Biomarkers; D011933:Reagent Kits, Diagnostic; D020107:Troponin T