Review article: The utility of troponin and other investigations in patients presenting to the emergency department with supraventricular tachycardia

Harith Fernando, Nicholas Adams, Biswadev Mitra

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

Patients with supraventricular tachycardia commonly present to the ED. There is a lack of consensus regarding assessment of these patients. Our aim was to determine the utility of troponin and four other investigations (full blood examination, electrolyte levels, thyroid function tests and chest X-rays) commonly requested for these patients. MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (January 1992-March 2017) were searched for randomised controlled trials and observational studies (of sample size greater than 10). Our search strategy yielded no randomised controlled trials and seven observational studies with significant statistical heterogeneity among selected studies (I2 87.3%, P < 0.001). Included studies investigated a total of 1155 patients. All studies reported on the utility of troponin testing in this patient population. The pooled proportion of patients investigated with troponin was 0.66 (95% confidence interval 0.44-0.88). The pooled proportion of positive troponin tests was 0.32 (95% confidence interval 0.23-0.41). Only one study reported on the utility of the remaining four investigations with abnormal results as follows: thyroid stimulating hormone 14%, haemoglobin 6%, white cell count 19% and chest X-ray 22%. Investigations are commonly requested for patients presenting with supraventricular tachycardia. Troponin testing is commonly performed with a high proportion of positive findings although these results did not appear to be associated with major adverse cardiac events. Heterogeneity among studies and low levels of evidence precluded conclusions on full blood examinations, electrolyte levels, thyroid testing and utility of chest X-rays in this patient population.

Original languageEnglish
Pages (from-to)35-42
Number of pages8
JournalEMA - Emergency Medicine Australasia
Volume31
Issue number1
DOIs
Publication statusPublished - Feb 2019

Keywords

  • Emergency medicine
  • Supraventricular
  • Tachycardia
  • Troponin

Cite this

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abstract = "Patients with supraventricular tachycardia commonly present to the ED. There is a lack of consensus regarding assessment of these patients. Our aim was to determine the utility of troponin and four other investigations (full blood examination, electrolyte levels, thyroid function tests and chest X-rays) commonly requested for these patients. MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (January 1992-March 2017) were searched for randomised controlled trials and observational studies (of sample size greater than 10). Our search strategy yielded no randomised controlled trials and seven observational studies with significant statistical heterogeneity among selected studies (I2 87.3{\%}, P < 0.001). Included studies investigated a total of 1155 patients. All studies reported on the utility of troponin testing in this patient population. The pooled proportion of patients investigated with troponin was 0.66 (95{\%} confidence interval 0.44-0.88). The pooled proportion of positive troponin tests was 0.32 (95{\%} confidence interval 0.23-0.41). Only one study reported on the utility of the remaining four investigations with abnormal results as follows: thyroid stimulating hormone 14{\%}, haemoglobin 6{\%}, white cell count 19{\%} and chest X-ray 22{\%}. Investigations are commonly requested for patients presenting with supraventricular tachycardia. Troponin testing is commonly performed with a high proportion of positive findings although these results did not appear to be associated with major adverse cardiac events. Heterogeneity among studies and low levels of evidence precluded conclusions on full blood examinations, electrolyte levels, thyroid testing and utility of chest X-rays in this patient population.",
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Review article : The utility of troponin and other investigations in patients presenting to the emergency department with supraventricular tachycardia. / Fernando, Harith; Adams, Nicholas; Mitra, Biswadev.

In: EMA - Emergency Medicine Australasia, Vol. 31, No. 1, 02.2019, p. 35-42.

Research output: Contribution to journalReview ArticleResearchpeer-review

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