Adoption of High-sensitivity Troponin Testing and Emergency Physician Ordering Behavior

Abstract

Introduction: Emergency departments (ED) are rapidly replacing conventional troponin assays with high-sensitivity troponin tests. We sought to evaluate emergency physician utilization of troponin tests before and after high-sensitivity troponin introduction in our ED. Methods: We retrospectively examined 9,477 ED encounters, identifying the percentage in which physicians ordered a serum troponin both before and after our institution adopted a high-sensitivity troponin test. Results: After introduction of high-sensitivity troponin testing, the percentage of ED encounters in which physicians ordered troponin studies decreased (28.3% before vs 22% after; P <.001), with the drop most pronounced in admitted patients (decrease of 10.9% [95% confidence interval [CI]: 7.3%–14.5%] in admitted patients vs decrease of 3.6% [95% CI: 1.7%–5.4%] in discharged patients; P<.001) Conclusion: Introduction of high-sensitivity troponin testing was associated with a decrease in troponin ordering. While the reasons for this are unclear, it is possible that physicians became more selective in their ordering behavior because of the lower specificity of high-sensitivity troponin.