Are all troponin assays equivalent in the emergency department?

INTRODUCTION: Cardiac-specific troponins (cTn) are recently-introduced, sensitive and specific markers of myocardial injury, and their absence should allow to safely exclude a coronary event. Various assays are commercially available but the relative advantage of each is not clear. Our objective was to compare the reliability of the two most commonly used troponin assays (cTnI and cTnT), in the emergency department (ED) for clinical decision when myocardial infarction (MI) or acute coronary syndrome (ACS) is suspected. METHODS: This prospective study included all patients arriving at the ED over a six-month period with chest pain or symptoms suggesting MI or ACS, in which diagnosis could not be confirmed due to absence of characteristic ECG features. All patients were tested with at least one of the two troponin assays available at the ED. RESULTS: Of the 54 included patients, ten (19%) were eventually diagnosed with MI/ACS. Qualitative assays for cTnI and cTnT identified the MI/ACS patients by both assays (respective positive predictive values of 0.5 and 0.7, and negative predictive values of 1.0 and 0.9). However, these assays were only partially correlated (R equals 0.49) and differed significantly. The quantitative assay for cTnI, but not for cTnT, discerned those who had MI/ACS (group A) from those who had other condition (group B) by their troponin levels (MI/ACS - 17.2 plus or minus 23.8 ng/ml versus others - 0.37 plus or minus 0.91 ng/ml, p is less than 0.001). CONCLUSION: In the ED, bedside assays of troponins are invaluable tools for the clinician, and their use is cost-effective. However, in the recommended cutoffs levels, only troponin I but not troponin T allowed the safe discharge of patients not requiring acute hospital care.

Quarrel involvement of school-aged children: gender differences, age trends, and school adjustment correlates.

How quarrel involvement (QI) relates to social likeability (SL) and scholastic attainment (SA) was investigated in a group of 201 Israeli school-aged children, boys and girls, from Grades 2, 4, and 6. QI as well as SL scores were obtained from peer ratings, and SA was rated by home-class teachers. The results indicate significant gender differences in QI, with boys being consistently rates as more involved in quarrels than girls. No overall developmental trend in QI was found. Very high correlations between peer ratings of QI submitted by boy raters and by girl raters indicate that QI was a reliably assessable personal characteristic. A clear inverse relation between QI and SL was found for both boys and girls from both cross-gender and within-gender perspectives, the only exception being a lack of such a relation for girls in fourth and sixth grades from the boys' perspective. A clear inverse relation between QI and SA was found for boys in all grade levels. This relation held only for girls in second grade, not for girls in fourth and sixth grades.