I would say that troponin shouldn't be checked in a patient presenting with chest pain which isn't obviously cardiac. In a patient presenting with a chest pain sounding of cardiac origin, a negative troponin (assuming correct timing post pain) won't rule out stable or unstable angina. In a scenario where the patient had a cardiac sounding chest pain on Saturday but only attended their GP on Monday, a positive troponin results would confirm myocardial damage has occurred and may be the need for urgent cardiology assessment.
Regards
Mohammad
Dr. M A Al-Jubouri, MB ChB, MSc, EurClinChem, FRCP Edin, FRCPath
Consultant Chemical Pathologist
--------------------------------------------
On Fri, 9/6/13, Hallworth Mike (RLZ) <[log in to unmask]> wrote:
Subject: Re: Troponin for GP patients
To: [log in to unmask]
Date: Friday, September 6, 2013, 10:59 AM
It depends to some extent on your
geography. In rural areas, where
patients may be 20 or 30 miles away from A&E, GPs find
it helpful to
check Tn in chest pain which isn't obviously cardiac.
We look out for them, do them as soon as possible after
receipt
(certainly same day) and phone the GP out of hours service
if raised.
Mike
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]]
On Behalf Of Fiona Davidson
Sent: 06 September 2013 10:54
To: [log in to unmask]
Subject: Troponin for GP patients
Dear All,
Are there any labs out there who DON'T offer troponin to
their GPs?
We are querying whether it is all that helpful - if a
patient appears
clinically to have had an MI then surely they should be
going straight
to A&E? GPs rarely mark samples as urgent and even
those that do very
often get missed at specimen reception and so get stuck
amongst the
hundreds of other GP samples waiting to be processed.
Once they finally
make it onto the analyser and a result is produced it often
isn't phoned
because the BMS' tend to assume that all raised troponins
are hospital
patients (which don't get phoned out). All in all the
whole process can
take at least a day and a half or up to 3 days if the sample
came in on
a Friday.
Add to this the fact that troponin is reportedly only stable
for 24
hours and I'm not sure we are offering a particularly useful
service
here.
When I have gone back and looked at the patients who had a
GP raised
troponin it didn't look like many of them were followed up
with a second
sample or even a hospital admission. The majority of
these are only
slightly raised ? due to e.g. CKD.
So my question is: would these patients be better served if
we didn't
offer GP troponin so that all those with a high probability
of MI come
straight to hospital? Has anybody done any work on
this?
Thanks
Fiona Davidson
Senior Biochemist
Kingston Hospital NHS Trust
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