Impact of Troponin-T determinations on hospital resource utilization and costs in the evaluation of patients with suspected myocardial ischemia.
Author: Zarich S, Bradley K, Seymour J, Ghali W, Traboulsi A, Mayall ID, Bernstein L.
Am J Cardiol 2001 88:732-736.
Background: The evaluation and triage of patients with suspected myocardial ischemia in the emergency department remains challenging and costly.
OBJECTIVE: To evaluate the impact of serial troponin T determinations on hospital resource utilization and costs in the entire spectrum of patients (both with and without chest discomfort) presenting to the emergency department with suspected myocardial ischemia.
Methods: Design: Prospective randomized trial. Setting: University-affiliated, community based emergency department. Patients: 856 patients with suspected myocardial ischemia. Intervention: Patients were randomized to receive a standard evaluation including serial electrocardiographic and creatine phosphokinase-MB determinations (controls) or a standard evaluation with the addition of serial troponin T determinations (troponin group). Measurements: Emergency department and hospital length of stay, bed utilization, and hospital charges.
Results: Significant reductions in length of hospital stay were seen in troponin T patients both with (3.6 vs 4.7 days; p = 0.01 ) and without (1.2 vs 1.6 days; p = 0.03 ) acute coronary syndromes as compared to controls. Total hospital charges were reduced in a similar fashion [($15,004 vs $19,202; p = 0.01 ) and ($4,487 vs $6,187; p = 0.17 ) respectively] in troponin patients as compared to controls. Troponin patients without acute coronary syndromes had fewer hospital admissions (25% vs 31%; p = 0.04 ) while troponin patients with acute coronary syndromes had shorter telemetry and CCU lengths of stay (3.5 vs 4.5 days; p = 0.03 ) as compared to controls.
Conclusion: Routine use of troponin T in a broad spectrum of emergency department patients with suspected myocardial ischemia can improve hospital costs and resource utilization.
