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Prevalence of myocarditis in pediatric intensive care unit cases presenting with other system involvement
Hanaa Ibrahim Rady1, Hanan Zekri1
1Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt.
Insights
Pediatric myocarditis often presents with non-cardiac symptoms, mimicking respiratory issues. Chest X-rays and echocardiograms are effective screening tools, with cardiac troponins confirming diagnosis in children.
Area of Science:
- Pediatric Cardiology
- Pediatric Critical Care Medicine
- Diagnostic Accuracy
Background:
- Myocarditis in children can present with non-specific symptoms, complicating early diagnosis.
- Accurate and timely diagnosis is crucial for appropriate management and improved outcomes in pediatric myocarditis.
Purpose of the Study:
- To evaluate the frequency of presenting symptoms in children diagnosed with myocarditis.
- To determine the diagnostic accuracy of various investigations, including cardiac enzymes, chest X-ray, and echocardiography, for pediatric myocarditis.
Main Methods:
- Observational study involving 63 pediatric intensive care unit (PICU) patients initially admitted for non-cardiac diagnoses.
- Diagnostic workup included cardiac enzymes (cardiac troponin T, creatine phosphokinase MB), chest X-ray, echocardiography, and electrocardiogram.
Main Results:
- 16 cases of definite myocarditis were identified, with a median age of 5.5 months; 62.5% were initially misdiagnosed with respiratory problems.
- Cardiac enzymes showed a diagnostic accuracy of 63.5%, while low fractional shortening (85.7%) and chest X-ray cardiomegaly (80.9%) were more accurate.
- Cardiac troponin achieved 100% specificity and 90.5% overall accuracy, with a 100% positive predictive value.
Conclusions:
- Pediatric myocarditis symptoms can be mistaken for other conditions, highlighting the need for high clinical suspicion.
- Chest X-ray and echocardiography serve as effective initial screening tests for suspected pediatric myocarditis.
- Cardiac troponins are valuable for confirming the diagnosis in patients who have undergone initial screening, offering high specificity.
Objective:
To assess children with myocarditis, the frequency of various presenting symptoms, and the accuracy of different investigations in the diagnosis.
Methods:
This was an observational study of 63 patients admitted to PICU with non-cardiac diagnosis. Cardiac enzymes, chest-X ray, echocardiography, and electrocardiogram were performed to diagnose myocarditis among those patients.
Results:
There were 16 cases of definite myocarditis. The age distribution was non-normal, with median of 5.5 months (3.25-21). Of the 16 patients who were diagnosed with myocarditis, 62.5% were originally diagnosed as having respiratory problems, and there were more females than males. Among the present cases, the accuracy of cardiac enzymes (cardiac troponin T [cTn] and creatine phosphokinase MB [CKMB]) in the diagnosis of myocarditis was only 63.5%, while the accuracy of low fractional shortening and of chest-X ray cardiomegaly was 85.7 and 80.9%; respectively. Cardiac troponin folds 2.02 had positive predictive value of 100%, negative predictive value of 88.7%, specificity of 100%, sensitivity of 62.5%, and accuracy of 90.5%.
Conclusions:
Children with myocarditis present with symptoms that can be mistaken for other types of illnesses. When clinical suspicion of myocarditis exists, chest-X ray and echocardiography are sufficient as screening tests. Cardiac troponins confirm the diagnosis in screened cases, with specificity of 100%.
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