title: "Real life use" of troponin in the emergency department: a survey of over 3000 cases.
abstract: BACKGROUND
  The aim of this study was to identify clinical variables which may be independently associated with positivity of a cardiac troponin I (cTnI) assay in a large population of patients admitted to the emergency department (ED).
  
  
  METHODS
  3166 subjects, with at least two troponin I tests ordered within 6 hours in the ED, were studied. Patient data were statistically analyzed to identify clinical associations with increased values of Troponin I.
  
  
  RESULTS
  Although patients with diagnosis of acute coronary syndrome displayed troponin I values significantly higher than those of other groups, positivity to troponin I (>40 ng/L) was also observed in patients with other clinical conditions. In multivariate analysis, age, elevated heart rate and electrocardiographic changes were independently associated with troponin I positivity at admission. In the whole study population troponin I positivity exhibited high sensitivity and negative predictive value, counterbalanced by low specificity and limited positive predictive value.
  
  
  CONCLUSIONS
  Troponin I positivity should be combined with history and clinical evaluation and cautiously interpreted in the ED, especially in patients exhibiting factors associated with higher troponin I levels such as older age, elevated heart rate or ECG changes.
authors.affiliation: Dipartimento di Scienze della Salute, Universitŕ del Piemonte Orientale, Novara, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Vidali
authors.affiliation: Dipartimento di Medicina Traslazionale, Universitŕ del Piemonte Orientale, Novara, Italy.
authors.forename: Enrica
authors.initials: E
authors.lastname: Verzotti
authors.affiliation: Dipartimento di Medicina Traslazionale, Universitŕ del Piemonte Orientale, Novara, Italy ; Medicina e Chirurgia d'Accettazione e d'Urgenza, Azienda Ospedaliero-Universitaria Maggiore della Caritŕ, Novara, Italy.
authors.forename: Nicole
authors.initials: N
authors.lastname: Cabraz
authors.affiliation: Dipartimento di Medicina Traslazionale, Universitŕ del Piemonte Orientale, Novara, Italy ; Medicina e Chirurgia d'Accettazione e d'Urgenza, Azienda Ospedaliero-Universitaria Maggiore della Caritŕ, Novara, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Santi
authors.affiliation: Dipartimento di Medicina Traslazionale, Universitŕ del Piemonte Orientale, Novara, Italy ; Medicina e Chirurgia d'Accettazione e d'Urgenza, Azienda Ospedaliero-Universitaria Maggiore della Caritŕ, Novara, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Puma
authors.affiliation: Dipartimento di Scienze della Salute, Universitŕ del Piemonte Orientale, Novara, Italy ; Laboratorio di Analisi Chimico-Cliniche, Azienda Ospedaliero-Universitaria Maggiore della Caritŕ, Novara, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bellomo
authors.affiliation: Cardiologia II, Azienda Ospedaliero Universitaria Maggiore della Caritŕ, Novara, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Lupi
authors.affiliation: Laboratorio di Analisi Chimico-Cliniche ed Ematologiche, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lippi
authors.affiliation: Dipartimento di Medicina Traslazionale, Universitŕ del Piemonte Orientale, Novara, Italy ; Medicina e Chirurgia d'Accettazione e d'Urgenza, Azienda Ospedaliero-Universitaria Maggiore della Caritŕ, Novara, Italy.
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Avanzi
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis; D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D002637:Chest Pain / Q000209:etiology; D017023:Coronary Angiography; D003920:Diabetes Mellitus / Q000453:epidemiology; D003937:Diagnosis, Differential; D004066:Digestive System Diseases / Q000097:blood / Q000175:diagnosis; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006403:Hematologic Tests / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D012120:Respiration Disorders / Q000097:blood / Q000175:diagnosis; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D019210:Troponin I / Q000097:blood*
chemical_list: D019210:Troponin I
keywords: acute coronary syndrome; chest pain; emergency service, hospital; troponin I