Evidence map›Paper›PMID 39095575›Full record

ArticleCJEM2024

Utility of serial troponin testing for emergency department patients with syncope.

Cameron W Leafloor, Andrew D McRae, Eric Mercier, Justin W Yan, Paul Huang, Muhammad Mukarram, Brian H Rowe, Aline C Ishimwe, Mona Hegdekar, Marco L A Sivilotti and 3 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in CJEM, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Cameron W LeafloorDepartment of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
Andrew D McRaeDepartment of Emergency Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada.
Eric MercierDepartment of Family Medicine and Emergency Medicine, Université Laval, Québec City, QC, Canada.
Justin W YanDivision of Emergency Medicine, Western University, London, ON, Canada.
Paul HuangDepartment of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada.
Muhammad MukarramClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Brian H RoweDepartment of Emergency Medicine and School of Public Health, College of Health Sciences, University of Alberta, Edmonton, AB, Canada.
Aline C IshimweClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Mona HegdekarDepartment of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada.
Marco L A SivilottiDepartments of Emergency Medicine, and of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.
Monica TaljaardClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Marie-Joe NemnomClinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
Venkatesh ThiruganasambandamoorthyDepartment of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. vthirug@ohri.ca.ORCID 0000-0003-4373-3688

Funding

AUTO21 Network of Centres of Excellence SRG-15-P10-001Canadian Institutes of Health Research (CIHR) MOP-114927Heart and Stroke Foundation of Canada G-15-0009006Physicians' Services Incorporated Foundation 09q4017
6 · The paper itself

Abstract

backgroundFor emergency department (ED) patients with syncope, cardiac troponin can identify acute coronary syndrome (ACS) and prognosticate for 30-day serious adverse events. However, it is unclear if serial testing improves diagnostic yield and prognostication.

methodsThis was a secondary analysis of data from two prospective studies conducted to develop the Canadian Syncope Risk Score. Adults (age ≥ 16 years) with syncope were enrolled, and patient characteristics, vital signs, physician diagnostic impression, electrocardiogram and troponin results, and adjudicated 30-day serious adverse event were collected. The primary outcome was the detection of a serious adverse event within 30 days of ED disposition. The secondary outcome was comparison of ED length of stay among patients with single versus serial troponin measurements.

results4996 patients [mean age 64.5 (SD 18.8) years, 52.2% male] were included: 4397 (89.8%) with single troponin [232 (5.3%) with serious adverse event in the ED and 203 (4.6%) after ED disposition]; 499 (10.2%) patients with > 1 troponin measurement [39 (7.8%) with serious adverse event in ED and 60 (12.0%) after ED disposition]. Among those with serial measurements, 10 patients (2.0%) had a rise from below to above the 99th percentile threshold, of whom 4 patients (0.8%) suffered serious adverse event: two with arrhythmias diagnosed on electrocardiogram, one with ACS and one suffered respiratory failure. Nine patients (1.8%) had Canadian Syncope Risk Score risk reclassification based on serial measurement, and none suffered 30-day serious adverse event. Median ED length of stay was significantly longer for patients with serial testing (5.6 vs. 3.8 h, p < 0.001).

conclusionsThe initial troponin measurement was sufficient for serious adverse event detection and in-ED risk stratification. Serial troponin testing does not improve the diagnostic yield or prognostication and should be reserved for patients with ongoing symptoms or electrocardiogram findings suggestive of cardiac ischemia.

Indexed as

ElectrocardiographyEmergency Service, HospitalSyncopeTroponinAcute Coronary SyndromeAgedBiomarkersCanadaFemaleHumansMaleMiddle AgedPrognosisProspective StudiesRisk AssessmentBiomarkersTroponinEmergency departmentSerial troponin testingShort-term serious adverse eventsSyncope

Identifiers

PMID39095575

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.