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Trends in cardiac troponin use in children and young adults: observational cohort study
Safe People
Organisation name
University of Edinburgh
Applicant name(s)
Dorien Kimenai
Funders/ Sponsors
HDR UK
Safe Projects
Project ID
DL_2023_056
Lay summary
When the heart is damaged cardiac troponin is being released in the bloodstream. Cardiac troponin tests measure the troponin level in the blood and are the preferred choice for the diagnosis of a heart attacks. However, clear cut-offs above which troponin values are suggestive of heart injury in children and young adults have not yet been defined. Additionally major concerns were raised within the COVID-19 pandemic in regards to heart involvement such as myocarditis in children and young adults after vaccinations. We will therefore examine whether an increase in troponin measurements has been observed over this time period and will further try to evaluate a cut-off above which troponin measurements in children and young adults are suggestive of heart injury.
Public benefit statement
Cardiac troponin is the gold standard biomarker to establish the diagnosis of myocardial infarction. Cardiac troponin testing in paediatric populations has been limited and there is little data or recommendations available for use in clinical practice. However, the recognition of myocardial injury is highly relevant for conditions that more frequently present in childhood, such as myocarditis, cardiomyopathies, or congenital heart diseases. Furthermore, the use of hs-cTn in children is likely to have increased during the COVID-19 pandemic and subsequent vaccination campaign due to specific concerns about cardiac involvement and myocarditis. Whilst in adult populations the 99th percentile threshold of cardiac troponin derived from a healthy reference population is the recommended diagnostic threshold for myocardial infarction, the manufacturers are not required to determine separate reference limits in children and young adults. The NHANES study has elucidated that the 99th percentile thresholds for four clinically applied cardiac troponin assays were lower in children than the 99th percentile thresholds determined in adults used in clinical practice. This possibly impacts the proportion of children and young adults diagnosed with myocardial injury when using paediatric sex-specific reference ranges derived from the NHANES study compared to manufacturer recommended thresholds derived from adult population. A systematic evaluation would therefore be informative for patients, physicians, and manufacturers.
Request category type
Public Health Research
Other approval committees
Latest approval date
07/05/2024
Safe Data
Dataset(s) name
DataLoch Heart Disease Registry
DataLoch COVID-19 Registry
Data sensitivity level
De-Personalised
Safe Setting
Access type
TRE