High-Sensitivity Troponin T Testing for Pediatric Patients in the Emergency Department.

Area of Science:

• Pediatric Cardiology
• Biomarkers
• Emergency Medicine

Background:

• The clinical utility of high-sensitivity cardiac troponin (hs-cTnT) in pediatric patients is debated.
• Myocardial injury is perceived as rare in children, with limited data on hs-cTnT efficacy.

Purpose of the Study:

• To evaluate the contribution of elevated hs-cTnT levels to clinical diagnoses in pediatric emergency department (ED) patients.
• To assess the diagnostic performance of hs-cTnT in identifying myocardial injury in children.

Main Methods:

• Retrospective cohort study of pediatric patients (0-18 years) presenting to the ED from 2018-2020.
• Measured hs-cTnT concentrations against sex-specific 99th percentile upper-reference limits (URLs) of 15 ng/L (males) and 10 ng/L (females).
• Compared hs-cTnT results with final clinical cardiac diagnoses.

Main Results:

• Out of 356 patients, 36 (10.1%) had elevated hs-cTnT. Twelve patients (3.4%) received a cardiac diagnosis, with 6 (50.0%) having elevated hs-cTnT.
• Serial hs-cTnT testing in 106 patients with initially normal levels showed subsequent elevations in 5 (4.6%), none with a cardiac diagnosis.
• Hs-cTnT demonstrated high specificity but low sensitivity for screening myocardial injury when clinical assessment was the gold standard.

Conclusions:

• Hs-cTnT testing in pediatric ED patients shows high specificity but low sensitivity for myocardial injury.
• Current hs-cTnT measurements do not strongly correlate with clinical diagnoses in this population.
• Further research is required to define the precise role of hs-cTnT in pediatric cardiac assessment.