Utilization of cardiac troponin assays in adult and pediatric populations: Guideline recommendations vs. reality.
OBJECTIVE
We hypothesized significant gaps remained for cardiac troponin (cTn) utilization in the United States, despite an emerging evidence base and guideline recommendations. We tested this hypothesis and investigated differences and trends between the use of cTn in adult versus pediatric hospitals.


METHODS
Individuals were identified by a targeted distribution through personal contact and professional society email lists. Participants completed an online survey (Qualtrics) from 07/15/13 to 07/26/13. The 31-item questionnaire used skipped logic and collected data about the respondent and their institutional cTn clinical practices. Data tabulation and analysis were conducted using Qualtrics and Microsoft Excel.


RESULTS
A total of 159 unique laboratories responded to the survey, representing primarily adult (81%) versus pediatric (19%) institutions. 59% of laboratories utilize the guideline recommended 99th percentile as the upper reference limit (URL) for cTn, with large variability in reporting practices among users of the same assay. 73% of laboratories reported simultaneous ordering of other cardiac biomarkers with cTn, a majority which included CK-MB. Interpretive comments were used with cTn in 71 laboratories with a significant amount of heterogeneity. Pediatric hospitals reported a lower frequency of cTn orders and were less likely to consider elevated cTn a critical value.


CONCLUSIONS
Gaps in current utilization and reporting of cTn exist, along with practices inconsistent with clinical guideline recommendations. Implementation of the 99th percentile and serial sampling protocols will be critical to adoption of high-sensitivity cTn assays. Differences in chest pain etiology are the most likely reason for the notable differences between cTn use in adults versus pediatric hospitals.
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905 USA. Electronic address: saen0006@umn.edu.
Amy K
AK
Saenger
Department of Pathology, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA. Electronic address: shaymond@luriechildrens.org.
Shannon
S
Haymond
D000328:Adult; D001681:Biological Assay / Q000706:statistics & numerical data*; D015415:Biomarkers / Q000097:blood; D002624:Chemistry, Clinical / Q000379:methods*; D002637:Chest Pain / Q000097:blood / Q000175:diagnosis*; D002648:Child; D052279:Creatine Kinase, MB Form; D005260:Female; D006801:Humans; D007753:Laboratories; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis*; D017410:Practice Guidelines as Topic; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires; D019210:Troponin I / Q000097:blood*; D020107:Troponin T / Q000097:blood*; D014481:United States
D015415:Biomarkers; D019210:Troponin I; D020107:Troponin T; D052279:Creatine Kinase, MB Form
Biomarkers; High-sensitivity troponin; Pediatrics; Troponin; Utilization