Lang William R, Cahill Kate E, Wark Tyler W, Gardner Rebekah L
Medicine The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Brown J Hosp Med. 2022 Jul 18;1(3):37011. doi: 10.56305/001c.37011. eCollection 2022.
Elevated serum troponin values, regardless of cause, are associated with increased short-term and long-term mortality. The objective of this study was to describe and quantify use of troponin-related terms in hospital discharge summaries.
Retrospective chart review.
We included patients admitted to the medical service of three Rhode Island hospitals in 2018. Patients had to have two or more troponin measurements, including at least one elevated value, as well as a rise-and-fall pattern. We reviewed text from three sections in the discharge summary-the problem list, hospital course, and attending attestation-to identify terms referring to troponin. We double-coded 10% of the sample to assess inter-rater reliability. Troponin terms were grouped by whether they referenced an abnormal level, as well as by the etiology of the elevation. Descriptive statistics were used.
257 patients were included; 66% of their discharge summaries had a troponin descriptor. We identified 19 unique troponin terms: three of these terms implied a normal troponin level (e.g., "flat troponin"), seven described an abnormal elevation without specifically referencing myocardial injury as the etiology (e.g., "troponin bump"), and the rest referenced ischemia or infarction (e.g., "NSTEMI"). Over one-third (34%) of the records had no troponin terms in the discharge summary, despite those patients having at least one abnormal troponin level during their hospitalization.
We found that clinicians used a wide variety of terms to describe troponin elevations in their discharge summaries, including minimizing language and potentially conflicting terms; a third of discharge summaries omitted any mention of the abnormal troponin value. More precise language may facilitate appropriate evaluation and management of these higher risk patients after hospital discharge.
无论病因如何，血清肌钙蛋白值升高均与短期和长期死亡率增加相关。本研究的目的是描述和量化出院小结中肌钙蛋白相关术语的使用情况。
回顾性病历审查。
我们纳入了2018年在罗德岛州三家医院内科住院的患者。患者必须进行过两次或更多次肌钙蛋白测量，包括至少一次升高值，并且要有升高和下降的模式。我们审查了出院小结中三个部分的文本——问题清单、住院过程和主治医生证明——以识别提及肌钙蛋白的术语。我们对10%的样本进行了双重编码，以评估评分者间的可靠性。肌钙蛋白术语根据是否提及异常水平以及升高的病因进行分组。使用描述性统计方法。
共纳入257例患者；其中66%的出院小结中有肌钙蛋白描述。我们识别出19个独特的肌钙蛋白术语：其中三个术语暗示肌钙蛋白水平正常（例如，“肌钙蛋白平稳”），七个描述了异常升高但未特别提及心肌损伤作为病因（例如，“肌钙蛋白波动”），其余的则提及了缺血或梗死（例如，“非ST段抬高型心肌梗死”）。尽管这些患者在住院期间至少有一次肌钙蛋白水平异常，但超过三分之一（34%）的记录在出院小结中没有肌钙蛋白术语。
我们发现临床医生在出院小结中使用了各种各样的术语来描述肌钙蛋白升高，包括淡化表述的语言和可能相互矛盾的术语；三分之一的出院小结遗漏了对异常肌钙蛋白值的任何提及。更精确的语言可能有助于在出院后对这些高危患者进行适当的评估和管理。
