Background: High sensitivity cardiac troponin T (HS-cTnT) is a well-established sensitive and specific prognostic marker in adults with acute coronary syndrome. Its prediction in children was not yet investigated.
Objectives: This study sought to evaluate if HS-cTnT elevation in the pediatric emergency center can predict worse patient outcome. Also, to evaluate if an early echocardiogram may improve this prediction.
Methods: All patients in the pediatric triage centers, who had HS-cTnT test during 2 years at the Hadassah medical centers Jerusalem Israel, were included. We calculated the positive predictive value and relative risk of HS-cTnT >7.5ng/l.
Results: We included 771 patients, of whom 40% had detectable levels of Hs-cTnT. Patients were divided into two groups of low and high HS-cTnT level, with a cutoff level of 7.5ng/l based on ROC analysis of different levels. The high HS-cTnT group (568 or 73.6%) was compared with the low HS-cTnT group (203 or 26.3%) for mortality and morbidity variables. In the high HS-cTnT group 17 (8.5%) patients died compared to only one patient (0.17%) in the low HS-cTnT group [OR:52.3; CI: 6.9 to 395.6, p.value<0.005]. Among the patients with the high HS-cTnT levels, 75 (37.1%) were admitted to ICU, compared with 24 (4.22%) in the low HS-group (OR:13.36; 95% CI: 8.1 to 21.99, p.value<0.005). 119 (58.6 %) of the high troponin group had an echocardiogram on site. Abnormal echo results did not increase the risk for death or ICU admission.
Conclusions: HS-cTnT is a strong indicator of disease severity as reflected by increased mortality and ICU stay in the general pediatric population. Elevations at levels below the limit of detection by traditional assays are significant as well. On-site echocardiogram does not improve prediction rate of these parameters.
