Mapping pediatric cardiac troponin testing worldwide: results from the IFCC survey on emerging applications,
Catherine L Omosule1,2, Tim Lang3, Sharon M Geaghan4
1Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA.
Insights
Global cardiac troponin (cTn) testing in children lacks standardized guidelines and pediatric-specific reference intervals, hindering appropriate interpretation. Urgent research is needed to establish evidence-based frameworks for pediatric cTn use.
Area of Science:
- Pediatric Cardiology
- Clinical Chemistry
- Laboratory Medicine
Background:
- Cardiac troponin (cTn) testing is crucial for diagnosing cardiac conditions, but its use in pediatric populations is limited by a lack of specific guidance.
- Congenital and acquired cardiac diseases pose a significant health burden in children, necessitating reliable diagnostic tools.
Purpose of the Study:
- To assess the global availability and utilization of cardiac troponin (cTn) testing in pediatric care.
- To identify key challenges and barriers to the effective use of cTn testing in pediatric laboratories and clinical practice.
Main Methods:
- An electronic survey was conducted by the IFCC Committee on Emerging Technologies in Pediatric Laboratory Medicine (C-ETPLM) in 2025.
- The survey targeted laboratory professionals and clinicians involved in pediatric care across 48 countries, gathering 439 responses.
Main Results:
- A significant proportion of laboratories (65.5%) offering cTn testing lacked pediatric-specific reference intervals, with considerable variability in existing intervals.
- High-sensitivity cTn assays were widely available, with rapid turnaround times reported by most.
- Lack of validated pediatric reference intervals, clinical guidelines, and standardized indications were consistently identified as major limitations.
Conclusions:
- The absence of outcome-based pediatric reference intervals and clear clinical guidance impedes the appropriate use of cTn testing in pediatric practice.
- Standardization of pediatric cTn interpretation, including decision thresholds and reference intervals, is urgently required.
- Pediatric-specific validation studies are essential to develop robust interpretive frameworks and clinical decision limits for cTn testing in children.
Objectives:
Limited guidance on the use and interpretation of cardiac troponin (cTn) testing in pediatric populations has restricted its broader adoption, despite the significant burden of congenital and acquired cardiac conditions in children. This survey aimed to evaluate global availability, utilization patterns, and key challenges associated with cTn testing in laboratories and among clinicians serving pediatric patients.
Methods:
The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Committee on Emerging Technologies in Pediatric Laboratory Medicine (C-ETPLM) conducted an electronic survey in 2025. Distributed to IFCC members and their networks over one month, the survey included 19 questions targeting both laboratory professionals and clinicians involved in pediatric care.
Results:
A total of 439 responses were collected from 48 countries spanning all continents, with 330 meeting eligibility criteria. Most respondents were laboratory specialists; clinicians represented 5.8 %. Among the 58.4 % who reported offering in-house cTn testing, 65.5 % lacked pediatric-specific reference intervals. Among those providing intervals, considerable variability existed in derivation, numerical limits, and sex-specific stratification. High-sensitivity cTn assays were widely available, and at least 71 % reported turnaround times under 2 hours. Clinicians indicated a broad range of indications for cTn testing in pediatric patients. Both clinicians and laboratory professionals consistently highlighted the lack of validated pediatric reference intervals, clear clinical guidelines, and standardized testing indications as major limitations.
Conclusions:
The absence of robust, outcome-based pediatric reference intervals, alongside limited clinical guidance and interpretive frameworks, remains a critical barrier to the effective and appropriate use of cardiac troponin testing in pediatric practice worldwide.
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