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    Short-term risk of adverse outcome is significantly higher in patients returning an abnormal troponin result when tested in the emergency department

    Access Status
    Open access via publisher
    Authors
    Flindell, J.
    Finn, Judith
    Gibson, N.
    Jacobs, Ian
    Date
    2009
    Type
    Journal Article
    
    Metadata
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    Citation
    Flindell, J. and Finn, J. and Gibson, N. and Jacobs, I. 2009. Short-term risk of adverse outcome is significantly higher in patients returning an abnormal troponin result when tested in the emergency department. EMA - Emergency Medicine Australasia. 21 (6): pp. 465-471.
    Source Title
    EMA - Emergency Medicine Australasia
    DOI
    10.1111/j.1742-6723.2009.01240.x
    ISSN
    17426731
    URI
    http://hdl.handle.net/20.500.11937/37239
    Collection
    • Curtin Research Publications
    Abstract

    Objective: Describe short-term mortality and hospitalization outcomes in patients undergoing troponin testing in Western Australia tertiary public hospital ED. Methods: Retrospective cohort study of adults presenting to urban tertiary ED between July 2000 and December 2004, and undergoing troponin inhibitory or tropomyosin binding testing. Patient data relating to ED attendance, troponins, hospitalization and death were linked using probabilistic data linkage. Troponin results were dichotomized (normal/abnormal) according to hospitals' cut-offs across various time periods. Presentations undergoing ED troponin testing, provided that it was not within 28 days of a previous discharge involving ED troponin testing, met study inclusion criteria. Logistical regression analyses quantified risk of subsequent hospitalization and death. Results: A total of 119 646 troponin tests were performed during 83 635 ED presentations involving 54 214 patients. For the 73 965 ED presentations meeting the study criteria, 6779 (9.2%) recorded an abnormal peak troponin level and 168 (2.5%) of these presentations were discharged directly from ED. After adjusting for covariates, those discharged directly from ED with abnormal troponin results were significantly more likely to die within 2 days (OR 60.4, 95% CI 31.9-114.2), 7 days (OR 31.2, 95% CI 17.9-54.3) and 28 days (OR 19.4, 95% CI 12.5-30.1) of discharge, compared with those with normal troponin results. Adjusted odds of subsequent hospital admission within 28 days following discharge from ED were 3.3 (95% CI 2.4-4.5) times greater for presentations with abnormal versus normal troponin results. Conclusion: An abnormal ED troponin result appears to be associated with increased risk of subsequent hospitalization and death within 28 days of discharge.

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