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Troponin Testing May Be Overused in Geriatric Patients

Findings show high false-positive rate in elderly with nonspecific complaints in the emergency department

TUESDAY, Jan. 21, 2020 (HealthDay News) — Routine troponin testing for acute coronary syndrome (ACS) may not be warranted in elderly patients with nonspecific complaints (NSCs) presenting to the emergency department, according to a study published in the January issue of Academic Emergency Medicine.

Alfred Z. Wang, M.D., from the Indiana University School of Medicine in Indianapolis, and colleagues retrospectively identified 594 patients aged ≥65 years triaged in the emergency department with NSCs from Jan. 1, 2017, to June 30, 2017. The rate of ACS and diagnostic yield of troponin testing was evaluated in patients without fever.

The researchers found that troponin was ordered in 69 percent of patients (mean age, 78.7 years; 58 percent female; and 75 percent admitted). One in five of these patients had troponin elevation. Overall, ACS occurred in 1.2 percent of 412 patients. Troponin had a sensitivity of 100 percent and specificity of 81 percent for detecting ACS. However, among patients with elevated troponin, 93.8 percent were false positives. Admission occurred in all patients with troponin elevation, but only one patient underwent angiography and no patients received reperfusion therapy.

“Given the false-positive rate in our study, our results may not support routine troponin testing for ACS in this population,” the authors write.

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