Global survey finds gaps in pediatric cardiac troponin testing

Cardiac troponin, a protein released into the blood when heart muscle is damaged, can be used as a quick measure of heart injury in adults, and testing for it has revolutionized adult cardiology. For children, however, doctors often lack data on normal troponin measurements.

A new global survey examined how this issue is being tackled around the world. Conducted by the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Committee on Emerging Technologies in Pediatric Laboratory Medicine (C-ETPLM), the study titled "Mapping pediatric cardiac troponin testing worldwide: results from the IFCC survey on emerging applications, standardization needs and access" was published in De Gruyter's international journal, Clinical Chemistry and Laboratory Medicine (CCLM).

The survey found that most laboratories testing children for cardiac troponin rely on reference intervals (the normal ranges doctors need to flag an abnormal result) designed for adults, not children.

Of the eligible respondents, 58.5% reported offering cardiac troponin testing in-house, but 65.5% of these lacked child-specific reference intervals. Laboratories often relied on manufacturer-provided reference intervals for adults. While a few clinics had set up child-specific troponin benchmarks, the researchers found inconsistencies: different clinics used different cutoffs, with no agreement on how to derive the correct reference-interval. Most clinicians and lab specialists surveyed identified this lack of consistent, validated child-specific guidelines as a major obstacle to giving children reliable heart care.

The problem runs deeper than just missing data, though. Heart attacks are rare in children, so doctors instead use troponin testing to help evaluate a wide range of very different child-specific conditions, from heart infections to Kawasaki disease to heart damage caused by cancer treatment. Because these conditions have little in common with adult heart disease, a single "normal range" borrowed from healthy children is not precise enough to be useful in all cases. The researchers argue that troponin testing needs different benchmarks tailored to each specific condition, rather than one generic reference range applied broadly.

"The IFCC Pediatric Committee for Emerging Technologies and I personally were driven by the belief that children deserve diagnostic care built around their biology, not borrowed from adult medicine," said Dr. Lianna G. Kyriakopoulou, Director of Genome Diagnostics at The Hospital for Sick Children and the University of Toronto, Canada. "To advance precision child health, we now need coordinated global action to develop pediatric reference intervals, strengthen clinical guidance, and ensure every child receives results that are accurate, meaningful, and equitable."