Physician The Children's Hospital at Montefiore Children's Hospital at Montefiore Astoria, New York, United States
Background: Throughout the COVID-19 pandemic there was an increased concern for cardiac disease in previously healthy pediatric patients, particularly myocarditis in the setting of Multisystem Inflammatory Syndrome in Children (MIS-C). As troponin, a marker of myocardial damage, was part of MIS-C screening algorithms it stands to reason that there was increased utilization in children presenting for emergency care with both classic cardiac symptoms and for symptoms associated with MIS-C such as fever or gastrointestinal symptoms. Understanding the trends in troponin utilization as well as assessing indications and outcomes of those tested can help guide future practice. Objective: The primary objective is to compare the rate of troponin utilization during the different stages of the COVID-19 pandemic. The secondary objective is to identify patterns in the indications for troponin testing and to investigate patient outcomes. Design/Methods: We are conducting a retrospective chart review of patients under 21 years of age who had a troponin ordered in the pediatric emergency department of a large urban quaternary care hospital, from April 1st, 2019 through March 31st, 2022. Medical records are being reviewed for demographic data, presenting symptoms, troponin results, additional cardiac related laboratory, imaging and procedural results, final diagnoses and outcomes. Patients with significant previous cardiac history will be excluded from the analysis for the secondary objective. Rates of troponin utilization will be assessed in 6 month intervals (4/1/2020- 9/30/2020, 10/1/20-3/31/21, 4/1/21-9/30/21, 10/1/21-3/31/22) and compared to baseline data (4/1/19-3/31/20) utilizing Chi-square tests. Descriptive statistics will be used to represent the remaining data including subgroup analysis by chief complaint, age and other demographic information. At the time of this submission, this project has been approved by the institutional IRB. Data collection is underway and will be completed this month. We plan to complete data analysis by March, 2024 to prepare for presentation and publication.
