Ravinder Sodi1, Trevor Hine, Alan Shenkin. 1. Department of Clinical Biochemistry and Metabolic Medicine, Royal Liverpool & Broadgreen University Hospital, Liverpool L7 8XP, UK. ravsodi@yahoo.com
Abstract
BACKGROUND: There is limited data and literature on the issue of cardiac troponin test requesting by general practitioners (GPs). It was therefore our aim to audit the cardiac troponin test requests made by GPs in our community with a view to develop an informed strategy for assay provision and reporting of results. METHODS: A retrospective audit was undertaken of data in our laboratory database for all cardiac troponin T (cTnT) tests requested by GPs between January and June 2005. A prospective audit was then carried out between July and December 2005 using the telephone interview method. The number and distribution of tests, the reasons for the request and the intended action by the GPs were quantified. RESULTS: Forty-five of 46 of the results of both the retrospective and prospective audits were negative based on the 99th percentile level with less than 10% imprecision (cTnT <0.03 microg/L). During the one-year study period, we had requests from 24 general practices with a mean and mode of two and one requests per general practice respectively. The most common reason for the request was found to be chest pain that had occurred more than 24 h ago. CONCLUSION: Bearing in mind the limitations of an audit study, our findings obviate the use of cTnT in general practice. We suggest that the laboratory should liase with the GP and advise referral for specialist care if clinical suspicion of acute coronary syndrome is high.
BACKGROUND: There is limited data and literature on the issue of cardiac troponin test requesting by general practitioners (GPs). It was therefore our aim to audit the cardiac troponin test requests made by GPs in our community with a view to develop an informed strategy for assay provision and reporting of results. METHODS: A retrospective audit was undertaken of data in our laboratory database for all cardiac troponin T (cTnT) tests requested by GPs between January and June 2005. A prospective audit was then carried out between July and December 2005 using the telephone interview method. The number and distribution of tests, the reasons for the request and the intended action by the GPs were quantified. RESULTS: Forty-five of 46 of the results of both the retrospective and prospective audits were negative based on the 99th percentile level with less than 10% imprecision (cTnT <0.03 microg/L). During the one-year study period, we had requests from 24 general practices with a mean and mode of two and one requests per general practice respectively. The most common reason for the request was found to be chest pain that had occurred more than 24 h ago. CONCLUSION: Bearing in mind the limitations of an audit study, our findings obviate the use of cTnT in general practice. We suggest that the laboratory should liase with the GP and advise referral for specialist care if clinical suspicion of acute coronary syndrome is high.