Role of Troponin Determination to Diagnose Chest Pain in the Pediatric Emergency Department

Abstract

Objectives: Chest pain is a common cause to admission to the pediatric emergency department and often leads to an extensive cardiac evaluation. The objective of this study was to evaluate the usefulness of the troponin (TN) plasma level determination in the initial phase of the differential diagnosis of chest pain in children.Methods: This is a retrospective observational study on 107 patients, aged 0 to 19 years, admitted for chest pain to the pediatric emergency department of our institution. Demographics, clinical data, and patient outcomes were analyzed. Troponin values of >0.03 ng/mL but <0.1 ng/mL were considered suspected for cardiac pathology, whereas levels of >0.1 ng/mL were indicative of cardiac pathology. In these latter patients, an echocardiographic examination was also performed. Results:Only 99 patients were evaluated with electrocardiogram (ECG).In 91 of 99 patients of our series, both TN determination and ECG recording were performed. Troponin was higher than the cutoff value (0.03 ng/ mL) in 9 patients (9.1%). Only 2 of the 9 patients who presented high TN values showed a nonpathological ECG, whereas 16 (17.5%) of 91 patients in whom both ECG and TN determination were performed had ECG abnormalities without a simultaneous elevation of TN. Of the 26 patients who had medical history and suggestive targets of cardiac pathology, only in 6 (23.1%) of them the diagnosis was confirmed. The final diagnosis of the 99 patients was idiopathic chest pain in 45.4% of cases.Conclusions: Even with the low cost and the relatively easiness for the plasma level determination, TN should be measured only in children with chest pain associated to familiar history suggestive of cardiovascular disease and/or clinical symptoms and/or ECG alterations.

Chest pain in pediatric patients in the emergency department- Presentation, risk factors and outcomes-A systematic review and meta-analysis

“…Pissarra et al reported that obtained ECG results were abnormal in 77.7% of their patients with cardiac etiologies of chest pain, and Lin et al reported that 84.5% of the patients had ECG abnormalities [ 18 , 23 ]. Additionally, Brancato et al reported that 23.2% of their patients’ ECGs were abnormal [ 14 ]. Cardiac causes of chest pain included myocarditis, pericarditis, myopericarditis, myocardial infarction, pulmonary embolism, pneumopericardium, and rhythm disturbances (supraventricular tachycardia, long QT syndrome, premature ventricular contraction).…”

“…Musculoskeletal chest pain was reported in nine studies with pooled prevalence = (0.357, 95% CI [0.202, 0.512]) [ 14 – 20 , 22 , 23 ]. I2 and p values were (99.8%, and p > 0.001, respectively) showing that pooled studies were heterogeneous.…”

Diagnostic testing for chest pain in a pediatric emergency department and rates of cardiac disease before and during the COVID-19 pandemic: a retrospective study

“…The number of imaging studies obtained during ED visits for pediatric chest pain varies widely in the literature, ranging from 16% ( 24 ) to 94% ( 6 ) for CXR, 20% ( 24 ) to 100% ( 25 ) for EKG and 1% ( 2 , 5 ) to 8% ( 24 ) for echocardiograms. While the number of CXR and EKG obtained in our study was within the range reported in the literature, echocardiograms were less frequently obtained in our study.…”

Chest Pain in Young Patients (5-15 Years) Referred to Pediatric Cardiology Outpatient Clinic

“…Only 5 patients had positive echocardiographic results. The major recommendations for treating people with chest pain include a thorough physical examination and a detailed medical history [20][21][22] . If substantial signs and symptoms are found in children with chest pain, help from a qualified pediatrician should be sought.…”