Myocarditis in a pediatric emergency department: a 10-year, single-center retrospective study

Background Pediatric myocarditis is caused by myocardial inflammation that can manifest a wide range of clinical courses, from mild symptoms to death, in the pediatric emergency department. This study aimed to identify risk factors or parameters to predict the clinical course of pediatric myocarditis. Methods This retrospective study included 46 patients who visited the pediatric emergency room at Severance Hospital. The patients were classified into spontaneous recovery (n=42) and extracorporeal membrane oxygenation (ECMO, n=4) groups, and their baseline characteristics, laboratory studies, and echocardiography findings were compared. Results Factors showing significant differences between the two groups included increased levels of inflammatory markers (delta neutrophil index, erythrocyte sedimentation rate, and C-reactive protein), aspartate aminotransferase (AST), and cardiac enzymes (creatine kinase-MB, N-terminal pro-B-type natriuretic peptide, and troponin-T) (p<0.001). Conclusions This study identified risk factors for fulminant myocarditis in pediatric patients with myocarditis who visited the emergency room, including increased levels of inflammatory markers, AST, and cardiac enzymes. Close monitoring and preparation for ECMO may be necessary if these risk factors are observed. These findings will be helpful for the early diagnosis and appropriate treatment of pediatric myocarditis.