Abstract
Troponin I is a widespread used blood test to confirm myocardial damage, usually attributable to myocardial infarction. Troponin tests require to be taken 12 hours after the initial event, and thus may be a potential cause for delay. SIGN and Hip Fracture Audit guidelines recommend 98% of patients obtaining surgery within 24hrs of admission.
A population of 347 neck of femur patients presenting to Glasgow Royal Infirmary were assessed over a one year period. 44 (13%) Patients were identified as having a pre-operative Troponin I test. Retrospective case note review of this patient cohort who had pre operative troponin testing was undertaken to identify timing of TnI testing, admission, surgery and medical comorbidies. Time to theatre was compared with the 24hr guideline.
From the cohort, 32 Patients had case notes which were located, of which 4 had no filed notes from the admission giving a 28 patient sample population. 18 (64%) had a Troponin of ‘negative’ value (<0.04 μg/l) of which the mean delay to theatre from admission was 46.4 hrs (median 44.5hrs). All 18 breached the 24hr target, 5 were delayed >48hrs. Of the 10 ‘postive’ patients, mean TnI was 0.4 and time to theatre was 85hrs (median 69hrs) with one excluded as treated conservatively. Only one patient was treated within the 24hr target (3.7% of sample group treated operatively) p=<0.001.
Scottish Hip Fracture Audit shows GRI to have an overall 98.6% compliance with the 24hr target. The data presented shows significant (near complete) failure to meet the 24hr target in patients tested preoperatively for Troponin I. Almost three-quarters of these patients have normal TnI, but delay may be attributable to additional comorbidities.
