Ruling out acute myocardial infarction based on a single high-sensitivity troponin measurement in the emergency department: a clinical practice review Article Swipe
Laura R Joyce
,
John W. Pickering
,
Martin Than
·
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.21037/jlpm-23-20
YOU?
·
· 2023
· Open Access
·
· DOI: https://doi.org/10.21037/jlpm-23-20
Emergency departments (EDs) around the world are under increasing pressure, with overcrowding increasing preventable errors, patient discomfort, violence and aggression, staff burnout, and patient morbidity and mortality. Chest pain is one of the most common reasons that patients present to the ED. Accelerated diagnostic pathways use clinical assessment, electrocardiograms and cardiac biomarkers to help emergency medicine providers to quickly and accurately identify patients who are at low risk of myocardial infarction, and who therefore can be safely discharged, whilst ensuring that high-risk patients receive prompt and appropriate care. Accelerated diagnostic pathways decrease ED length of stay, which may reduce overcrowding. The diagnosis of acute myocardial injury has previously required at least two cardiac troponin measurements to be taken at least 6–12 hours apart. More recently, the use of accelerated diagnostic pathways in conjunction with high sensitivity cardiac troponin assays, allow a single sample measuring very low troponin concentration to be used to exclude acute myocardial injury. This enables the early discharge of a significant number of patients presenting to EDs with possible acute coronary syndrome, therefore decreasing ED overcrowding and improving patient flow. This clinical practice review describes the clinical perspective of ED specialists which differs from that of cardiologists and clinical chemists. We summarise the development of decision-making pathways for the assessment of chest pain, and describe the current changes taking place in pathway use involving single test rule out of acute myocardial infarction in the ED. The purpose of this clinical practice review is to provide clinical biochemists with an understanding of how emergency clinicians use and approach cardiac troponin results within the ED.
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Metadata
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.21037/jlpm-23-20
- OA Status
- diamond
- Cited By
- 2
- Related Works
- 10
- OpenAlex ID
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All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4385351482Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.21037/jlpm-23-20Digital Object Identifier
- Title
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Ruling out acute myocardial infarction based on a single high-sensitivity troponin measurement in the emergency department: a clinical practice reviewWork title
- Type
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articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
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2023Year of publication
- Publication date
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2023-07-01Full publication date if available
- Authors
-
Laura R Joyce, John W. Pickering, Martin ThanList of authors in order
- Landing page
-
https://doi.org/10.21037/jlpm-23-20Publisher landing page
- Open access
-
YesWhether a free full text is available
- OA status
-
diamondOpen access status per OpenAlex
- OA URL
-
https://doi.org/10.21037/jlpm-23-20Direct OA link when available
- Concepts
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Medicine, Emergency department, Overcrowding, Myocardial infarction, Chest pain, Acute coronary syndrome, Troponin, Intensive care medicine, Emergency medicine, Myocardial infarction diagnosis, Medical emergency, Internal medicine, Economics, Psychiatry, Economic growthTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
2Total citation count in OpenAlex
- Citations by year (recent)
-
2025: 1, 2024: 1Per-year citation counts (last 5 years)
- Related works (count)
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.care. | 88 |
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| abstract_inverted_index.differs | 196 |
| abstract_inverted_index.enables | 158 |
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| abstract_inverted_index.injury. | 156 |
| abstract_inverted_index.pathway | 225 |
| abstract_inverted_index.patient | 16, 24, 182 |
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| abstract_inverted_index.ensuring | 80 |
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| abstract_inverted_index.pathways | 45, 91, 131, 210 |
| abstract_inverted_index.patients | 38, 63, 83, 167 |
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| abstract_inverted_index.practice | 186, 244 |
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| abstract_inverted_index.describes | 188 |
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| abstract_inverted_index.discharge | 161 |
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| abstract_inverted_index.clinicians | 257 |
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| cited_by_percentile_year.min | 90 |
| corresponding_author_ids | https://openalex.org/A5025452062 |
| countries_distinct_count | 1 |
| institutions_distinct_count | 3 |
| corresponding_institution_ids | https://openalex.org/I2802773633 |
| sustainable_development_goals[0].id | https://metadata.un.org/sdg/16 |
| sustainable_development_goals[0].score | 0.5600000023841858 |
| sustainable_development_goals[0].display_name | Peace, Justice and strong institutions |
| citation_normalized_percentile.value | 0.6884465 |
| citation_normalized_percentile.is_in_top_1_percent | False |
| citation_normalized_percentile.is_in_top_10_percent | False |