TY - JOUR
T1 - Defensive Medicine in an Emergency Department
T2 - The Overuse of High-Sensitivity Cardiac Troponin I Testing
AU - Sayyad, Mohammed Hani
AU - Levi, Nir
AU - Bruoha, Sharon
AU - Zalut, Todd
AU - Taha, Louay
AU - Karmi, Mohammad
AU - Perel, Nimrod
AU - Maller, Tomer
AU - Zacks, Netanel
AU - Sherm, Maayan
AU - Fink, Noam
AU - Sabouret, Pierre
AU - Nasir, Khurram
AU - Bar-Sheshet, Sarit
AU - Glikson, Michael
AU - Asher, Elad
N1 - Publisher Copyright:
© 2024 by the authors.
PY - 2024/12/1
Y1 - 2024/12/1
N2 - Introduction: Cardiac troponin I is routinely measured in patients with suspected acute coronary syndrome. However, when a high-sensitivity cardiac troponin I (hs-cTnI) test is ordered without a clear clinical indication, unexpectedly elevated levels can lead to unnecessary diagnostic workups and inappropriate management. This study aimed to investigate physicians’ rationale for performing hs-cTnI tests in an emergency department (ED). Methods: In this prospective study, 1890 patients who underwent hs-cTnI measurement during their stay in an ED were included. Upon arrival, patients were classified into two groups based on their chief complaints: cardiac (36.6%) and non-cardiac (63.4%). Forty-seven ED physicians were asked to complete a questionnaire to assess their perspectives on the use of high-sensitivity cardiac troponin I (hs-cTnI) testing in the ED. Results: Out of the 47 ED physicians who responded to the questionnaire (94% response rate), 97.9% indicated that the purpose of hs-cTnI testing in the ED was to diagnose an acute cardiac event. However, 38.3% reported ordering hs-cTnI tests in non-cardiac patients due to medicolegal concerns. Additionally, 53% admitted to working under medicolegal pressure, and 50% believe they would have ordered fewer hs-cTnI tests if not for this medicolegal threat. Conclusions: defensive medicine is prevalent among ED physicians, and routine use of hs-cTnI testing as part of an evaluation can be explained in part by concern about liability and defensive medicine.
AB - Introduction: Cardiac troponin I is routinely measured in patients with suspected acute coronary syndrome. However, when a high-sensitivity cardiac troponin I (hs-cTnI) test is ordered without a clear clinical indication, unexpectedly elevated levels can lead to unnecessary diagnostic workups and inappropriate management. This study aimed to investigate physicians’ rationale for performing hs-cTnI tests in an emergency department (ED). Methods: In this prospective study, 1890 patients who underwent hs-cTnI measurement during their stay in an ED were included. Upon arrival, patients were classified into two groups based on their chief complaints: cardiac (36.6%) and non-cardiac (63.4%). Forty-seven ED physicians were asked to complete a questionnaire to assess their perspectives on the use of high-sensitivity cardiac troponin I (hs-cTnI) testing in the ED. Results: Out of the 47 ED physicians who responded to the questionnaire (94% response rate), 97.9% indicated that the purpose of hs-cTnI testing in the ED was to diagnose an acute cardiac event. However, 38.3% reported ordering hs-cTnI tests in non-cardiac patients due to medicolegal concerns. Additionally, 53% admitted to working under medicolegal pressure, and 50% believe they would have ordered fewer hs-cTnI tests if not for this medicolegal threat. Conclusions: defensive medicine is prevalent among ED physicians, and routine use of hs-cTnI testing as part of an evaluation can be explained in part by concern about liability and defensive medicine.
KW - defensive medicine
KW - emergency department
KW - troponin
UR - https://www.scopus.com/pages/publications/85213358575
U2 - 10.3390/life14121563
DO - 10.3390/life14121563
M3 - Article
C2 - 39768271
AN - SCOPUS:85213358575
SN - 2075-1729
VL - 14
JO - Life
JF - Life
IS - 12
M1 - 1563
ER -