Its important to understand that in the US the FDA has not yet approved the high-sensitivity (hs) troponin assays. Therefore we are still talking about the so-called contemporary troponin assays. The current assay is a good test, and the high-sensitivity troponin will have even better from an analytical perspective at lower values.
In either case the “differential” is not as important as WHEN to order it. With increased sensitivity (primarily when hs assays are here) there will be more positive values. Therefore adequate clinical judgement is primordial.
In other words, yes, cardiac contusion, burns, sepsis, etc can be part of the differential.
But the take-home point for all clinicians, especially the ones placing the first order (usually in ED), would be to use the test wisely, weighing in pre-test probability and understanding the basics of the test such as coefficient of variation (CV) and the 99th percentile.
We do not usually order D-dimer in patients with sepsis or post-surgery for example. Why would you?
Same with troponin.
Order the test in patients with a suspicioun for ischemia and you are working up for ACS.
Otherwise, you will deal with many positive values that might not change your plan, but even trigger potentially unnecessary work up and evaluation.
In conclusion, a test is as good as the physician who orders it.