An Evaluation of the Appropriateness of Prescribing Ultrasensitive Cardiac Troponin I in the Emergency Department of the Mohammed V Military Training Hospital in Rabat

Abstract

In emergency medicine, Troponin Ic is a useful diagnostic and prognostic biomarker in the management of ischemic cardiac pathologies. However, its prescription often exceeds international recommendations. The aim of this study is to evaluate practices concerning the prescription of Troponin assays in the emergency department of the Mohammed V Military Training Hospital in Rabat. This is a prospective study. Was included in this study, every patient admitted to the emergency department of the Mohammed V Military Training Hospital in Rabat and having at least one troponin assay during the period from December 25, 2020 to January 12, 2021. The assay was performed using the "ARCHITECT STAT Highly sensitive troponin-I" method. 135 patients for whom have prescribed a Troponin assay during the period of study. A total of 219 assays were performed. The mean age was 64 years, with a predominance of males. The main reasons for admission were chest pain (29.6%), dyspnea (26.6%), neurological disorders (16.3%) and respiratory distress (10.3%). A high Troponin Ic value during the first determination was observed in almost 37% of cases. In 63% of cases, the value was negative. 53.3% of prescriptions were considered as irrelevant according to pre-established criteria. A repeated Troponin Ic assays were performed in 31% (n=127) of cases. They were deemed relevant in 25% of cases. In 6% of patients, the appropriateness of repeat assays was not demonstrated. Compliance with good prescribing practices for Troponin significantly reduces the number of unjustified samples, with a real economic impact.