Saenger Amy K, Haymond Shannon
Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905 USA.
Department of Pathology, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA.
Clin Biochem. 2015 Dec;48(18):1213-8. doi: 10.1016/j.clinbiochem.2015.08.008. Epub 2015 Aug 12.
We hypothesized significant gaps remained for cardiac troponin (cTn) utilization in the United States, despite an emerging evidence base and guideline recommendations. We tested this hypothesis and investigated differences and trends between the use of cTn in adult versus pediatric hospitals.
Individuals were identified by a targeted distribution through personal contact and professional society email lists. Participants completed an online survey (Qualtrics) from 07/15/13 to 07/26/13. The 31-item questionnaire used skipped logic and collected data about the respondent and their institutional cTn clinical practices. Data tabulation and analysis were conducted using Qualtrics and Microsoft Excel.
A total of 159 unique laboratories responded to the survey, representing primarily adult (81%) versus pediatric (19%) institutions. 59% of laboratories utilize the guideline recommended 99th percentile as the upper reference limit (URL) for cTn, with large variability in reporting practices among users of the same assay. 73% of laboratories reported simultaneous ordering of other cardiac biomarkers with cTn, a majority which included CK-MB. Interpretive comments were used with cTn in 71 laboratories with a significant amount of heterogeneity. Pediatric hospitals reported a lower frequency of cTn orders and were less likely to consider elevated cTn a critical value.
Gaps in current utilization and reporting of cTn exist, along with practices inconsistent with clinical guideline recommendations. Implementation of the 99th percentile and serial sampling protocols will be critical to adoption of high-sensitivity cTn assays. Differences in chest pain etiology are the most likely reason for the notable differences between cTn use in adults versus pediatric hospitals.
我们推测，尽管有新出现的证据基础和指南建议，但美国在心肌肌钙蛋白（cTn）的使用方面仍存在显著差距。我们对这一假设进行了验证，并调查了成人医院与儿科医院在cTn使用上的差异和趋势。
通过个人联系和专业协会电子邮件列表进行有针对性的分发来确定研究对象。参与者在2013年7月15日至2013年7月26日期间完成了一项在线调查（Qualtrics）。这份31项的问卷采用了跳过逻辑，并收集了关于受访者及其机构cTn临床实践的数据。使用Qualtrics和微软Excel进行数据制表和分析。
共有159个不同的实验室回复了调查，主要代表成人机构（81%）和儿科机构（19%）。59%的实验室将指南推荐的第99百分位数作为cTn的参考上限（URL），同一检测方法的使用者在报告实践中存在很大差异。73%的实验室报告同时订购了其他心脏生物标志物和cTn，其中大多数包括肌酸激酶同工酶（CK-MB）。71个实验室在使用cTn时使用了解释性注释，存在大量异质性。儿科医院报告的cTn检测订单频率较低，且不太可能将升高的cTn视为危急值。
目前在cTn的使用和报告方面存在差距，同时存在与临床指南建议不一致的做法。采用第99百分位数和连续采样方案对于采用高敏cTn检测至关重要。胸痛病因的差异最有可能是成人医院与儿科医院在cTn使用上存在显著差异的原因。
