Big drop in troponin testing during pandemic 

COVID-19 restrictions have had a significant impact on the use of pathology testing with researchers in South Australia reporting a drop in the number of troponin tests requested during the state’s first lockdown compared to earlier in the year.

According to the analysis of records from SA Pathology, falling test rates were seen across community and ED settings – most pronounced for haematology, general chemistry and endocrinology tests. The only exception was microbiology molecular tests, which includes virology PCR testing, which were three times higher during the lock down period compared to earlier in the year.

In the community setting, the ratio of number of pathology tests pre-lockdown and post- lockdown vs. baseline period decreased from 1.02 to 0.53 respectively.

The number of troponin tests carried out in emergency departments, as an indicator of urgent care, decreased in the lockdown period compared to the baseline period. The researchers said an inverse association between patient age and numbers of troponin tests in lockdown might have arisen because avoidance behaviour was more pronounced in older age groups who were at increased risk of suffering severe effects associated with COVID-19.

“This may suggest either that there were fewer occurrences of ACS or that people with ACS did not present to EDs during the lockdown period,” they wrote. “The latter theory is supported by a report that during the peak COVID-19 outbreak in New York in the first half of 2020 there was a doubling of out of hospital deaths concurrent with a halving of ACS hospitalisations.”

“However, it has also been suggested that a more sedentary lifestyle, and less smoking may have led to a decrease in people who suffer ACS.”
The study authors also noted there was no evidence of an association between tests result (positive vs negative) and time period.

Noting that South Australia was one of the few locations in the world with the lowest incidence of COVID-19 during the early stage of the pandemic, researchers described the resulting impact on pathology request rates as ‘interesting.’

“In South Australia the health care system was not overburdened by COVID-19 cases during the study period and as such did not represent a barrier to patient presentations at ED. The behaviour of not seeking treatment for urgent care conditions needs to be addressed in preparation for further possible COVID-19 restrictions and other pandemics.”

Read more in the Internal Medicine Journal.

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