Choosing Wisely:

Don’t order troponins for the routine evaluation of pediatric chest pain in the absence of a concerning history or ECG abnormalities.

Rationale and Comments: Troponin-I levels are a valuable tool for the assessment of adult patients who present with chest pain. However, these levels are not as useful in the pediatric population. Troponin levels in the great majority of pediatric patients presenting with chest pain are normal. Furthermore, troponin levels have not been shown to reliably correlate with disease severity or prognosis in many cardiac diseases known to cause chest pain in pediatric patients. However, in a few circumstances, such as a family history of very early cardiovascular disease or a history suggestive of myocarditis/pericarditis, consideration of troponin levels is reasonable. Therefore, do not order troponin levels for the routine evaluation of pediatric chest pain in the absence of a concerning history or ECG abnormalities.
Sponsoring Organizations:
  • American Academy of Pediatrics – Section on Cardiology and Cardiac Surgery
  • Sources:
  • Expert consensus
  • Disciplines:
  • Pediatric
  • Emergency medicine
  • Cardiovascular
  • References: • Brown JL, Hirsh DA, Mahle WT. Use of troponin as a screen for chest pain in the pediatric emergency department. Pediatr Cardiol. 2012;33(2):337-342.
    • Liesemer K, Casper TC, Korgenski K, Shaji SC. Use and misuse of serum troponin assays in pediatric practice. Am J Cardiol. 2012;110(2): 284-289.

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