Mapping pediatric cardiac troponin testing worldwide: results from the IFCC survey on emerging applications, standardization needs and access

OBJECTIVES: Limited guidance on the use and interpretation of cardiac troponin (cTn) testing in pediatric populations has restricted its broader adoption, despite the significant burden of congenital and acquired cardiac conditions in children. This survey aimed to evaluate global availability, utilization patterns, and key challenges associated with cTn testing in laboratories and among clinicians serving pediatric patients. METHODS: The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Committee on Emerging Technologies in Pediatric Laboratory Medicine (C-ETPLM) conducted an electronic survey in 2025. Distributed to IFCC members and their networks over one month, the survey included 19 questions targeting both laboratory professionals and clinicians involved in pediatric care. RESULTS: A total of 439 responses were collected from 48 countries spanning all continents, with 330 meeting eligibility criteria. Most respondents were laboratory specialists; clinicians represented 5.8 %. Among the 58.4 % who reported offering in-house cTn testing, 65.5 % lacked pediatric-specific reference intervals. Among those providing intervals, considerable variability existed in derivation, numerical limits, and sex-specific stratification. High-sensitivity cTn assays were widely available, and at least 71 % reported turnaround times under 2 hours. Clinicians indicated a broad range of indications for cTn testing in pediatric patients. Both clinicians and laboratory professionals consistently highlighted the lack of validated pediatric reference intervals, clear clinical guidelines, and standardized testing indications as major limitations. CONCLUSIONS: The absence of robust, outcome-based pediatric reference intervals, alongside limited clinical guidance and interpretive frameworks, remains a critical barrier to the effective and appropriate use of cardiac troponin testing in pediatric practice worldwide. SUMMARY OF OUTCOMES: - Pediatric cardiac troponin interpretation lacks standardization, with no universally accepted clinical guidelines, decision thresholds, or harmonized reference intervals supported by robust outcome-based evidence. - Most pediatric reference intervals are extrapolated from adult data or secondary sources, including manufacturer package inserts, despite clear biological and analytical justification for age- and sex-specific pediatric limits. - The clinical application of troponin in children differs from adults: whereas troponin is central to acute myocardial infarction diagnosis in adults, AMI is rare in children. In pediatrics, troponin is more frequently used to evaluate inflammatory and non-ischemic cardiac conditions, such as myocarditis. - There is an urgent need for pediatric-specific validation studies to establish appropriate interpretive frameworks, clinical decision limits, and outcome-driven guidance for cardiac troponin testing in children.