The Utility of Troponin in Predicting Cardiac Dysfunction in Pediatric Patients: A Meta-Analysis

In the management of adults, troponins are routinely used to detect acute coronary syndrome and to predict increased risk of mortality. However, there is limited information available on the utility of troponin for risk assessment in children with chest pain. This study aimed to investigate whether elevated troponin in pediatric patients (0-21 years of age, as per guidelines during the sampling timeframe) presenting with chest pain has a role as a prognostic biomarker for myocardial dysfunction. In a systematic review and meta-analysis, searches were scoped with language restriction to English on PubMed and Cochrane from their inception to 2023. Evidence included studies reporting the association of elevated troponin with myocardial dysfunction. A summary of odds ratios for the association of elevated troponin with myocardial dysfunction was generated. The Quality in Prognosis Studies tool was used to assess methodological quality. Six studies involving 3,144 patients presenting with chest pain were included in the analysis. The risk of myocardial dysfunction was greater in subjects with elevated troponin than in those without (odds ratio, 3.30; 95% confidence interval, 2.19-4.40). Considerable interstudy heterogeneity (I² statistic 87%) was observed and partially explained by variations in study design, troponin subtype, and overall risk of bias. Elevated troponin is associated with myocardial dysfunction in children presenting with chest pain in this sample. Further high-quality multisite studies are needed to inform clinical application of these findings.