P2.B021: A Retrospective Review of the Utility of High Sensitivity Troponin Testing in Pediatric Patients

Background: Chest pain is a frequent complaint among pediatric patients, with cardiac causes being relatively rare. High-sensitivity troponins (hs-cTnI and hs-cTnT) have emerged as valuable tools in assessing chest pain, being utilized in many adult and children’s hospitals. They are validated tools particularly useful in the adult population, yet data on their validity in the pediatric population remain limited. This study aims to retrospectively evaluate the utility of high-sensitivity troponins obtained at referring facilities in pediatric patients transferred to our facility for chest pain, comparing values obtained at referral facilities to conventional cardiac troponin levels obtained here.

Methods: A retrospective chart review was conducted on pediatric patients referred to our children’s hospital emergency department from January 2020 to December 2022, due to elevated high-sensitivity troponin markers. Chart data were extracted from each patient who met inclusion criteria, including high-sensitivity troponin values, diagnostic workups obtained at the referring facility (i.e., other labs, EKGs, imaging, etc.), Troponin-I values obtained at our facility, continued workup at our facility, demographic information. Final billing diagnosis was used to determine if the patient's presentation was cardiac in nature. For statistical analysis, chi-square or Fisher’s exact test was used to assess the association between HS Troponin and risk factors. T-test was used to compare patients’ weight between HS Troponin groups. Logistic regression was used to assess the association between HS Troponin and Cardiac Troponin I/T, adjusted for the impact of gender and weight. Adjusted Odds Ratio (aOR) was computed by logistic regression model. All statistical analyses were performed using SPSS 28 (Chicago, IL). All statistical tests were 2-sided, and p< 0.05 were considered statistically significant.

Results: The study revealed a significantly higher percentage of high-sensitivity troponin in patients with normal cardiac troponin I/T levels (Diff %=45.2, 95% CI [21.5, 68.8], p=0.007). The high-sensitivity troponin assays had a positive predictive value of 0.29. There was no significant association found between high-sensitivity troponin and other risk factors. Logistic regression analysis did not support a significant association between high sensitivity troponin and cardiac troponin (p=0.90), gender (adjusted Odds Ratio [aOR]=0.66, 95% CI [0.11, 3.85], p=0.64), or weight (aOR=1.02, 95% CI [0.98, 1.06], p=0.25).

Conclusion: This retrospective review highlights the oversensitivity of High Sensitivity Troponin testing in pediatric patients presenting with chest pain. While these are useful in the detection of myocardial damage in the adult population, they are not validated for children, and their use can lead to additional healthcare costs in terms of further diagnostic work-up, hospital admissions, etc. Further research is warranted to understand this testing in pediatric patients. Such insights could enhance diagnostic accuracy and inform clinical decision-making in pediatric cardiology settings.