Medical Case Reports

Audit of Irrelevant Troponin Levels Taken in an A&E Unit and Waste of HSE Resources as a Result

Aim: To outline inappropriate percentage of levels of troponin taken without clinical suspicion
of ACS and the waste of resources it consequently led to.
Methods: Data was collected from admission department in A and E, Naas General Hospital,
for two consecutive weeks in December 2020. 165 patients were selected from a total of
245 patients admitted. Selection criteria was based on serum troponin levels sent to the lab,
clinical suspicion of ACS (analyzing symptoms, clinical examination and ECG findings from
patient’s charts) and further cardiac investigations carried.
Results: 75/165 of troponins (45.45%) were done with no clinical suspicion of a cardiac
problem. Of these, 38/75-were positive troponins. However, only 17 patients were labeled
as having ACS, subsequently giving a diagnostic yield of 10.30% of the total troponins taken.
Conclusion: 58/165 (35.15%) of investigations were totally irrelevant which is a very high
worrying factor and led to further waste of resources. Investigations should only be requested
when ACS is suspected and in the context of clinical history and examination.

Author(s):

Mihaiela Boestean * Huzaifa Dawood and Niall Hickey

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