Evidence map›Paper›PMID 39768271›Full record

ArticleLife (Basel, Switzerland)2024

Defensive Medicine in an Emergency Department: The Overuse of High-Sensitivity Cardiac Troponin I Testing.

Mohammed Hani Sayyad, Nir Levi, Sharon Bruoha, Todd Zalut, Louay Taha, Mohammad Karmi, Nimrod Perel, Tomer Maller, Netanel Zacks, Maayan Sherm and 6 more

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Article in Life (Basel, Switzerland), 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0cells of the map it votes in
0citing papers in PubMed
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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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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

16 authors.

Mohammed Hani SayyadEmergency Department, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel.
Nir LeviJesselson Integrated Heart Center, Shaare Zedek Medical Center, Eisenberg R&D Authority and Faculty of Medicine, The Hebrew University of Jerusalem, 12 Shmuel Beit Street, Jerusalem 9103102, Israel.
Sharon BruohaDepartment of Cardiology, Barzilai University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Ashkelon 7830604, Israel.ORCID 0000-0002-0282-7533
Todd ZalutEmergency Department, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112001, Israel.
Louay TahaJesselson Integrated Heart Center, Shaare Zedek Medical Center, Eisenberg R&D Authority and Faculty of Medicine, The Hebrew University of Jerusalem, 12 Shmuel Beit Street, Jerusalem 9103102, Israel.
Mohammad KarmiJesselson Integrated Heart Center, Shaare Zedek Medical Center, Eisenberg R&D Authority and Faculty of Medicine, The Hebrew University of Jerusalem, 12 Shmuel Beit Street, Jerusalem 9103102, Israel.
Nimrod PerelJesselson Integrated Heart Center, Shaare Zedek Medical Center, Eisenberg R&D Authority and Faculty of Medicine, The Hebrew University of Jerusalem, 12 Shmuel Beit Street, Jerusalem 9103102, Israel.ORCID 0000-0002-5149-8836
Tomer MallerJesselson Integrated Heart Center, Shaare Zedek Medical Center, Eisenberg R&D Authority and Faculty of Medicine, The Hebrew University of Jerusalem, 12 Shmuel Beit Street, Jerusalem 9103102, Israel.
Netanel ZacksJesselson Integrated Heart Center, Shaare Zedek Medical Center, Eisenberg R&D Authority and Faculty of Medicine, The Hebrew University of Jerusalem, 12 Shmuel Beit Street, Jerusalem 9103102, Israel.
Maayan ShermJesselson Integrated Heart Center, Shaare Zedek Medical Center, Eisenberg R&D Authority and Faculty of Medicine, The Hebrew University of Jerusalem, 12 Shmuel Beit Street, Jerusalem 9103102, Israel.
Noam FinkAssuta Medical Centers, Tel Aviv 6329302, Israel.
Pierre SabouretACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75005 Paris, France.ORCID 0000-0002-0243-3673
Khurram NasirHouston Methodist DeBakey Heart and Vascular Institute, Houston Methodist Hospital, 6550 Fannin St., Houston, TX 77030, USA.
Sarit Bar-SheshetClinical Laboratory Division, Shaare Zedek Medical Center, Jerusalem 9103102, Israel.
Michael GliksonJesselson Integrated Heart Center, Shaare Zedek Medical Center, Eisenberg R&D Authority and Faculty of Medicine, The Hebrew University of Jerusalem, 12 Shmuel Beit Street, Jerusalem 9103102, Israel.
Elad AsherJesselson Integrated Heart Center, Shaare Zedek Medical Center, Eisenberg R&D Authority and Faculty of Medicine, The Hebrew University of Jerusalem, 12 Shmuel Beit Street, Jerusalem 9103102, Israel.ORCID 0000-0003-3381-605X

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionCardiac troponin I is routinely measured in patients with suspected acute coronary syndrome. However, when a high-sensitivity cardiac troponin I (hs-cTnI) test is ordered without a clear clinical indication, unexpectedly elevated levels can lead to unnecessary diagnostic workups and inappropriate management. This study aimed to investigate physicians' rationale for performing hs-cTnI tests in an emergency department (ED).

methodsIn this prospective study, 1890 patients who underwent hs-cTnI measurement during their stay in an ED were included. Upon arrival, patients were classified into two groups based on their chief complaints: cardiac (36.6%) and non-cardiac (63.4%). Forty-seven ED physicians were asked to complete a questionnaire to assess their perspectives on the use of high-sensitivity cardiac troponin I (hs-cTnI) testing in the ED.

resultsOut of the 47 ED physicians who responded to the questionnaire (94% response rate), 97.9% indicated that the purpose of hs-cTnI testing in the ED was to diagnose an acute cardiac event. However, 38.3% reported ordering hs-cTnI tests in non-cardiac patients due to medicolegal concerns. Additionally, 53% admitted to working under medicolegal pressure, and 50% believe they would have ordered fewer hs-cTnI tests if not for this medicolegal threat.

conclusionsdefensive medicine is prevalent among ED physicians, and routine use of hs-cTnI testing as part of an evaluation can be explained in part by concern about liability and defensive medicine.

Indexed as

defensive medicineemergency departmenttroponin

Identifiers

PMID39768271
PMCPMC11677696

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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.