Calling Critical Troponin Values Using Significant Delta Rises in Serial Draws Instead of a Hard Cutoff to Help Identify Non-ST-Elevated Myocardial Infarction

Abstract Introduction Non-ST-elevated myocardial infarction diagnoses rely more heavily on lab values. In this study, we examined the effectiveness of an algorithm calculating delta rise in troponins to identify critical values. Using this algorithm in combination with a system to directly call physicians for critical values would improve treatment time for these patients. Methods Troponin values were measured using Abbott Architect Stat TnI assay. Reports for 09/01/17 to 11/30/17 were generated using Beaker module of our Epic EHR. Results A total of 11,233 troponin values were evaluated for critical values. A total of 108 patients were identified as NSTEMI patients (troponin ordered as well as dual antiplatelet and/or high-dose heparin treatment). In total, 106 NSTEMI patients, or 98.14%, had a critical value using a 0.3-ng/mL cutoff. Eighty-six patients, or 79.63%, had critical values using the algorithm. Of the 106 criticals from a 0.3-ng/mL cutoff, only 76 would be called before treatment was ordered compared to 66 of the 86 criticals using the algorithm. Over 3 months, the algorithm would have called 485 total critical results while a 0.3-ng/mL cutoff would have called 1,913. Conclusions A 0.3-ng/mL cutoff had a higher percentage of critical results for NSTEMI patients, but similar numbers of clinically actionable critical results were identified by both methods. Upon further chart review of the 10 discrepant criticals identified by the cutoff but not the algorithm, 2 were identified as false-positive NSTEMI and 5 could be caught with minor algorithm adjustments. The algorithm was able to identify NSTEMI within a clinically actionable timeframe as effective as a 0.3-ng/mL cutoff with 75% fewer criticals called over a 3-month period, allowing criticals called directly to treating physicians to improve time to treatment.