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I feel I must reply to this as I find it both insulting to our colleagues and points to our limitations. Sometimes I wonder why we act as though our colleagues are idiots as opposed why we do not understand our role is to help them deal with the limitations of the tests. 

I have personally not switched to TnT-hs as I do not think it is so simple for either the Emergency Department doctors or cardiologists. An entire data base of experience is being pulled out from under their feet for something that is as yet not fully tried. Look at the nonsense that occurred with MDRD. (I never put it into our lab results, following discussion with our Nephrologists). The limitations were known at the beginning and still we, as a group,  we put it in place. BNP was similar. Most hospitals jumped on that bandwagon in North America.  In the JGH we only do it batches and only the Primary Pulmonary Hypertension and Congestive Heart Failure clinics get it. It was difficult for a few years to fight for this using the epidemiology, sensitivity and specificity but now the Cardiologists are very glad they did not open it up as their consults would have gone through the roof. 

New tests are never just a question of numbers but of impact on practice. Small changes in tests sensitivity etc can have huge changes on patient flow, workload and length of stay in ERs, cardiologists consults, use of in-patient admissions, CCU beds etc. If TnT produces an improvement in overall health of all patients is not yet know as it moves out of studies into general hospitals. 

On the other hand I love your explanation of it moving from a yes no test to a CK like test. One day I may get around to using it, when eventually I switch to it. 

Liz Mac Namara
Jewish General Hospital 
Montreal, Quebec





On 2010-11-29, at 4:05 AM, Reynolds Tim <[log in to unmask]> wrote:

We have changed to ng/L to get away from all of the decimals.
 
The cardiologists have suddenly panicked at the large numbers and worry more...  [they don't understand units smaller than £300/hr/private patient]   ;-)
 
Their main problem was that this was a more sensitive assay [they thought that meant we would be picking up more myocardial infarctions]. It took a very long time for them to understand that sensitivity related to the functional sensitivity of the assay. Once they were told that it meant TnT was now like CK [i.,e can give a measurable value within the normal range], they were even more upset because it ruined their perfect marker [measurable = MI; not measurable = normal]. They do not like it thta they now have to think about how to interpret the result.
 


TIM

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-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Mainwaring-Burton Richard (South London Healthcare NHS Trust)
Sent: 26 November 2010 11:23
To: [log in to unmask]
Subject: Reporting Troponin T

G'day all
 
With the availability of the 'ultra' sensitive Troponin T assays, what are punters views on reporting units ?
 
"Traditional" units are µg/L, but that now means reporting in 3 decimal places.
 
Have many folks changed to ng/L resulting in whole numbers.
Will report back consensus if one exists. Should this be done fomally by the EQAS schemes ?
 
 

with best wishes

Richard

Richard Mainwaring-Burton

Consultant Biochemist

South London Healthcare Trust

Queen Mary's Hospital

Sidcup, Kent,  DA14 6LT

020-8308-3084

mob: 07831-739876


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