Serum Cardiac Troponin I in the Evaluation of Nonaccidental Trauma

• Published in: The Journal of pediatrics 2015-09, Vol.167 (3), p.669-673.e1
• Main Authors: Bennett, Berkeley L., MD, MS, Steele, Paul, MD, Dixon, Cinnamon A., DO, MPH, Mahabee-Gittens, E. Melinda, MD, MS, Peebles, Jarrod, BS, Hart, Kimberly W., MA, Lindsell, Christopher J., PhD, Chua, Michael S., MD, Hirsh, Russel, MD
• Format: Article
• Language: English
• Subjects: Biomarkers - blood; Child Abuse - statistics & numerical data; Child, Preschool; Emergency Service, Hospital; Female; Humans; Infant; Male; Pediatrics; Prospective Studies; Troponin I - blood; Wounds and Injuries - blood
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2015.05.042

Objective To determine if troponin I is more often elevated in children with suspected nonaccidental trauma (NAT) compared with uninjured children of similar age, and describe associations between troponin I elevation and NAT injuries. Study design Prospective 2-group study of children less than 2 years of age presenting to the emergency department with nonaccidental abdominal, thoracic, or intracranial injuries, and similarly aged uninjured children. Primary outcome was serum troponin I (≥0.04 ng/mL) using frozen blood samples from the 2 groups. Secondary outcomes included descriptive analyses of age, injury characteristics, and clinical appearance. Results There were 129 subjects; 60 injured patients and 69 uninjured patients. Groups had similar age and sex. Troponin I was elevated in 38% of injured children compared with 17% of uninjured children ( P  = .008). No uninjured patient over 3 months of age had elevated troponin I. Abdominal trauma, acute rib fractures, or the child's ill-appearance in the emergency department were associated with having elevated troponin I. Conclusions Troponin I is more often elevated in children with suspected NAT than uninjured children. Elevation of troponin I in children greater than 3 months of age with suspected NAT is concerning for trauma. Occult cardiac injury is more likely to occur in children with inflicted abdominal trauma, acute rib fractures, or ill appearance.