Using pediatric 97.5th centile URLs increased myocardial injury identification by 28% compared to adult 99th centile in children and young adults; infants showed much higher hs-cTn levels.
Does the use of paediatric upper reference limits for high-sensitivity cardiac troponin change the proportion of children and young adults identified with myocardial injury compared to adult reference limits?
Utilizing paediatric 97.5th centile URLs increases the proportion of children identified with myocardial injury compared to adult 99th centiles, while paediatric and adult 99th centiles identify similar numbers, though none appear applicable to infants <1 year.
Absolute Event Rate: 0% vs 0%
Abstract Background High sensitivity cardiac troponin I (hs-cTnI) and T (hs-cTnT) assays can identify myocardial injury in children and young adults, but there is a lack of data and guidance on their use in this clinical setting1,2. Whether the use of a 97.5th or 99th centile upper reference limits (URLs) from a healthy paediatric population would be more appropriate in this population than using the adult 99th centiles defined by assay manufacturers is uncertain. Methods An international, multi-centre, retrospective cohort study was conducted across four hospitals in Norway and the United Kingdom to determine trends in hs-cTn testing and the impact of applying paediatric or adult URLs on the identification of myocardial injury. Consecutive children and young adults (≤18 years) were enrolled on the first occasion they underwent hs-cTn testing between 2013 and 2023. Cardiac troponin was measured during clinical care with either a hs-cTnI or hs-cTnT assay according to local clinical practice. Trends were evaluated in the volume of hs-cTn testing in relation to creatinine testing, and the proportion of patients with cardiac troponin concentrations above the local URL, the manufacturer’s adult sex-specific 99th centile, and sex-specific paediatric 99th and 97.5th centiles defined in the NHANES cohort at each site3. Clinical diagnoses of myocarditis and pericarditis during this period were identified through linkage with healthcare registries. Results In total, 9,833 children and young adults (46.6% female) underwent cardiac troponin testing during the study period. Of these, 1,771 (18.0%) had hs-cTn concentrations above the sex-specific adult 99th centile, compared with 1762 (17.9%) above the sex-specific paediatric 99th centile and 2,261 (23.0%) above the sex-specific paediatric 97.5th centile (a relative increase of 28%). Infants (1 year of age) had markedly higher hs-cTn values than other age ranges (89.3% above the sex-specific paediatric 99th centile vs 9.1%). Troponin testing in children and young adults increased during the study period at three out of four sites, particularly during the COVID19 pandemic. Case numbers of myocarditis and pericarditis remained low, with no clear association identified between testing volume and disease incidence. Conclusions This multi-centre international cohort study identified significant heterogeneity in patterns of cardiac troponin testing between sites, despite consistently low rates of myocarditis and pericarditis. Utilising paediatric 97.5th centile URLs would increase the proportion of children and young adults identified with myocardial injury, whereas paediatric and adult sex-specific 99th centiles identified similar numbers. None of these reference limits appear applicable to infants (1 year of age), and our findings highlight the need for specific guidance in this group.Patient demographics Annual trends in troponin testing
Thurston et al. (Sat,) reported a other. Using pediatric 97.5th centile URLs increased myocardial injury identification by 28% compared to adult 99th centile in children and young adults; infants showed much higher hs-cTn levels.