PEDIATRIC PATIENTS WITH ELEVATED HIGH-SENSITIVITY TROPONIN T IN THE EMERGENCY DEPARTMENT: A 3-YEAR RETROSPECTIVE COHORT STUDY

Abstract

Objective: To evaluate the diagnostic contribution of high sensitivity cardiac troponin T (hs cTnT) and identify predictors for hospitalization in children presenting to the pediatric emergency department (ED) with symptoms suggestive of cardiac disease and elevated hs cTnT. Methods: Retrospective cohort study of 305 patients aged 4–18 years with hs cTnT > 99th. percentile (14 ng/L) presenting to a pediatric ED (April 2023 – November 2025). Demographic, clinical, electrocardiographic, echocardiographic, and laboratory data were analyzed. Multivariate logistic regression identified independent predictors of inpatient status. Results: Mean age was 11.9 ± 4 years (72% male). Chief complaints: chest pain (75.7%), shortness of breath (12.1%), palpitations (6.5%). Overall, 84/305 (27.5%) were hospitalized (8 in intensive care). Inpatients had significantly lower ejection fraction (63.4±9.1% vs. 68.6±2.4%, p<0.001) and higher hs cTnT (674.7±901.5 vs. 46.5±78.4 ng/L, p<0.001), CK MB, AST, ALT, LDH, and CRP. Independent inpatient predictors: hs cTnT (OR = 1.012, p<0.001), AST (OR = 1.034, p=0.002), ALT (OR = 1.027, p=0.003), CRP (OR = 1.009, p=0.014). ECG abnormalities (ST elevation, low QRS voltage) and echocardiographic findings (EF <54%, pericardial effusion, aortic/mitral regurgitations) were almost exclusively seen in inpatients. Outpatients (72.5%) had normal ECG (98%) and echocardiogram (97%) with only mild troponin elevations and no adverse events during follow up (mean 15 months). Conclusion: Most pediatric patients who presented with symptoms suggestive of cardiac disease with mildly elevated hs cTnT, normal ECG, and preserved EF can be safely managed as outpatients. In patients suspected of having a diagnosis of myopericarditis or perimyocarditis, elevated hs cTnT >100 ng/L, abnormal ECG, raised inflammatory markers and hepatic transaminase (AST/ALT), reduced EF, predict need for hospitalization.