Thanks Matt,
Do you have a reference or is anyone on this list from Sheffield?
I'm really after some specifics.
Eg
Timing of troponin testing
Whether anyone is using rapid rule out with myoglobin / CK at 2 hours (or
whenever)
Whether anyone has a good tool for deciding who is so low risk that they
don't require testing at all. As an example of this, is there a lower age
limit below which you say it's just not worth it. And before anyone says no
I'm assuming that you don't do late troponin testing / stress ECGs on 9 year
olds with chest pain. Or, perhaps you do. My department sees a lot of
people with atypical pain in their twenties and thirties who have no good
alternate diagnosis. A lot of my colleagues keep these patients in for late
(12h) troponin testing.
Rates of stress ECG positivity
Whether stress ECG needs to be done contemporaneously with the admission, or
whether it can be done in the few days following presentation.
Whether stress ECG is the right test, or should it be stress echo, or some
sort of myocardial perfusion scan.
What sort of rates of true positives are achieved from stress ECGs
Ie the nuts and bolts of all of this.
These patients don't make up a huge %age of our work. But, when they are
held for late troponin testing they do take up a huge %age of ED monitor
time as they don't get admitted to CCU (I assume this is the same in most
locations).
I've looked at our rates of late troponin positivity and it's about 1:250
for those with an initial negative troponin who are not considered high risk
enough to be sent to the Cardiologists...... That's 995 people waiting for
up to 13.5 hours (lab takes 1.5 hours to get us a troponin result) for 5
patients found.
PB
-----Original Message-----
From: Accident and Emergency Academic List
[mailto:[log in to unmask]] On Behalf Of Dunn Matthew Dr. (RJC) A &
E - SwarkHosp-TR
Sent: Wednesday, 28 March 2007 4:11 PM
To: [log in to unmask]
Subject: Re: Assessment of possibly ischaemic chest pain
Work from Sheffield on this. Put patient in assessment area; check
troponins; exercise ECG; allow clinical judgement.
Matt Dunn
Warwick
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