Diagnostic and prognostic value of cardiac troponins in emergency department patients presenting after a fall: A prospective, multicenter study

Abstract

BackgroundEmergency department (ED) presentations after a ground‐level fall (GLF) are common. Falls were suggested to be another possible presenting feature of a myocardial infarction (MI), as unrecognized MIs are common in older adults. Elevated high‐sensitivity cardiac troponin (hs‐cTn) concentrations could help determine the etiology of a GLF in ED. We investigated the prevalence of both MI and elevated high‐sensitivity cardiac troponin T (hs‐cTnT) and I (hs‐cTnI), as well as the diagnostic accuracy of hs‐cTnT and hs‐cTnI regarding MI, and their prognostic value in older ED patients presenting after a GLF.MethodsThis was a prospective, international, multicenter, cohort study with a follow‐up of up to 1 year. Patients aged 65 years or older presenting to the ED after a GLF were prospectively enrolled. Two outcome assessors independently reviewed all discharge records to ascertain final gold standard diagnoses. Hs‐cTnT and hs‐cTnI levels were determined from thawed samples for every patient.ResultsIn total, 558 patients were included. Median (IQR) age was 83 (77–89) years, and 67.7% were female. Elevated hs‐cTnT levels were found in 384 (68.8%) patients, and elevated hs‐cTnI levels in 86 (15.4%) patients. Three patients (0.5%) were ascertained the gold standard diagnosis MI. Within 30 days, 18 (3.2%) patients had died. Nonsurvivors had higher hs‐cTnT and hs‐cTnI levels compared with survivors (hs‐cTnT 40 [23–85] ng/L in nonsurvivors and 20 [13–33] ng/L in survivors; hs‐cTnI 25 [14–54] ng/L in nonsurvivors and 8 [4–16] ng/L in survivors; p < 0.001 for both).ConclusionsA majority of patients (n = 364, 68.8%) presenting to the ED after a fall had elevated hs‐cTnT levels and 86 (15.4%) elevated hs‐cTnI levels. However, the incidence of MI in these patients was low (n = 3, 0.5%). Our data do not support the opinion that falls may be a common presenting feature of MI. We discourage routine troponin testing in this population. However, hs‐cTnT and hs‐cTnI were both found to have prognostic properties for mortality prediction up to 1 year.