Çocuk Acil Servislerinde Serum Troponin-I Değerlendirilmesi Gerekli mi? Tek Merkez Deneyimi

Yıl 2024, Cilt: 34 Sayı: 6, 839 - 845, 31.12.2024

Aysun Tekeli , Muhammet Furkan Kalın , Şeyma Kayalı

https://doi.org/10.54005/geneltip.1533661

Öz

Amaç: Miyokardiyal hücrelerin yapısal bir proteini olan troponin, erişkin hasta yönetiminde kardiyak hasarın bir göstergesi olarak sıklıkla kullanılmaktadır. Pediatrik hastalarda kardiyak biyobelirteçlerin kullanımına artan ilgiye rağmen, klinik uygulamalarda rutin kullanımı için yerleşik bir kılavuz yoktur. Bu çalışmada çocuk acil servisine çeşitli klinik şikayetlerle başvuran ve troponin düzeyi istenen hastaların demografik özellikleri, semptomları, muayene ve takip sonuçları ile serum troponin düzeylerinin tanıdaki rolünü retrospektif olarak değerlendirmeyi amaçladık.
Yöntemler: İki yıllık sürede çocuk acil servisimize başvuran ve troponin düzeyi istenen 1 ay-18 yaş arası hastaların demografik özellikleri, semptomları, muayeneleri, tetkikleri ve takipleri retrospektif olarak incelendi.
Bulgular: Çalışmaya alınan 1890 hastanın %50,9'u kadındı ve yaş ortalamaları 12,36±4,32 yıl idi. En sık kardiyak troponin isteme nedenleri göğüs ağrısı (%59,1), zehirlenme (%10), çarpıntı (%8,3) ve senkop (%7) idi. Kardiyak troponin sadece 55'inde (%2,9) normal referans aralığına göre yüksek bulunmuştur. Troponin düzeyi yüksek olan hastalarda en sık görülen yakınma göğüs ağrısıydı (n=29, %52,7). İleri tetkiklerde 5 hastada miyokardit ve 2 hastada MIS-C tanısı konulurken, troponin yükselmesinin en yaygın kalp dışı nedeni karbon monoksit zehirlenmesiydi.
Sonuçlar: Tıbbi öykü, fizik muayene ve elektrokardiyografi ile kardiyak patoloji şüphesi olan hastalarda troponin testi yapılması gereksiz tetkik ve maliyetleri azaltmak için gereklidir. Ek olarak, troponin düzeylerinin yorumlanmasında hastanın genel klinik değerlendirmesi dikkate alınmalıdır.

Anahtar Kelimeler

çocuk, çocuk acil, kardiyak, kardiyak dışı, troponin

Is Serum Troponin-I Evaluation Necessary in Pediatric Emergency Departments? Single Center Experience

Öz

Abstract:
Aim: Troponin, a structural protein of myocardial cells, is frequently used in adult patient management as an indicator of cardiac damage. Despite the growing interest in using cardiac biomarkers in pediatric patients, there is no established guideline for its routine use in clinical practices. In this study, we aimed to retrospectively evaluate the demographic characteristics, symptoms, examinations and follow-up results of patients who applied to the pediatric emergency service with various clinical complaints and requested troponin levels, and the role of serum troponin levels in diagnosis.
Methods: We retrospectively analyzed the demographic characteristics, symptoms, examinations, examinations and follow-ups of patients aged 1 month to 18 years, who applied to our pediatric emergency department and required troponin levels over a two-year period. Results: Out of the 1890 patients included in the study, 50.9% were female, and their mean age was 12.36±4.32 years. The most common reasons for requesting cardiac troponin were chest pain (59.1%), poisoning (10%), palpitations (8.3%), and syncope (7%). Only 55 (2.9%) of the cardiac troponin tests were found to be elevated based on the normal reference range. Among the patients with elevated troponin levels, chest pain was the most frequently observed complaint (n=29, 52.7%). On further examination, 5 patients were diagnosed with myocarditis and 2 patients with MIS-C, while the most common noncardiac cause of troponin elevation was carbon monoxide poisoning.
Conclusions: Performing troponin tests in patients with suspected cardiac pathology based on their medical history, physical examination, and electrocardiography is necessary to reduce unnecessary testing and costs. Additionally, interpreting troponin levels should take into account the patient’s overall clinical evaluation

Anahtar Kelimeler

Children, pediatric emergency, cardiac, non-cardiac, troponin

Kaynakça

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