Troponin testing in primary care: can it improve diagnosis and prevent admission?

Abstract

Introduction: With the growing demand on emergency departments, expanses in the clinical capabilities of prehospital healthcare facilities have become a hot topic. The use of point-of-care troponin testing (POCTT) has been greatly debated due to the sensitivity limitations of the current testing machines. The current systematic review will collate the current research and attempt to confirm whether troponin testing in primary care can improve diagnostic capabilities and prevent onward admission where appropriate. Methods: The literature search was carried out using PubMed and Embase databases with MeSH terms derived from the US National Library of Medicine. Key data points were extracted pertaining to areas such as cost, unnecessary admission, incorrect diagnosis and mortality, with a descriptive analysis completed. Results: Cost – An overall improvement in cost of patient care was noted. Unnecessary admission – A reduction in unnecessary admission was reported. Acute coronary syndrome (ACS) exclusion – Improved ACS exclusion was assumed due to improved admission rates. Mortality – No POCTT-associated mortality was reported. Incorrect diagnosis – Misdiagnosis rates between 1.02–5.2% with some associated morbidity. Conclusion: POCTT could be safely used when combined with current risk-stratification tools and delayed testing to mitigate the limitations with low-sensitivity testing.