{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:38:39Z","timestamp":1791581919888,"version":"4.3.4"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T00:00:00Z","timestamp":1768953600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["FS\/CRTF\/25\/24735"],"award-info":[{"award-number":["FS\/CRTF\/25\/24735"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["FS\/IBSRF\/23\/25161"],"award-info":[{"award-number":["FS\/IBSRF\/23\/25161"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["RE\/24\/130012"],"award-info":[{"award-number":["RE\/24\/130012"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Norway Regional Health Authority","award":["F-12821"],"award-info":[{"award-number":["F-12821"]}]},{"name":"Research Excellence Award","award":["CH\/F\/21\/90010"],"award-info":[{"award-number":["CH\/F\/21\/90010"]}]},{"name":"Research Excellence Award","award":["RG\/20\/10\/34966"],"award-info":[{"award-number":["RG\/20\/10\/34966"]}]},{"name":"Research Excellence Award","award":["RE\/24\/130012"],"award-info":[{"award-number":["RE\/24\/130012"]}]},{"DOI":"10.13039\/501100005029","name":"Western Norway Regional Health Authority","doi-asserted-by":"publisher","award":["F-12976"],"award-info":[{"award-number":["F-12976"]}],"id":[{"id":"10.13039\/501100005029","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The role of high-sensitivity cardiac troponin (cTn) assays for children and young adults is uncertain, and no guidance is available on diagnostic thresholds. This study evaluates the effect of applying pediatric compared to adult upper reference limits (URLs) for cTn.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We carried out a retrospective multicenter international cohort study of consecutive children and young adults (1 day to 18 years) undergoing cTn I or T testing at 4 tertiary care hospitals in Norway and Scotland, United Kingdom, from 2013 to 2023. Myocardial injury was classified using the adult sex-specific 99th percentile URL, a pediatric sex-specific 99th percentile, and a pediatric sex-specific 97.5th percentile. Diagnoses of myocarditis were obtained from the Norwegian Patient Register and the Scottish Morbidity Record.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 9833 (46.6% female) children and young adults underwent cTn testing. Applying the adult sex-specific 99th percentile, 1771 (18.0% [95% CI, 17.3%\u201318.8%]) had myocardial injury compared with 1762 (17.9% [95% CI, 17.2%\u201318.7%]) using a pediatric 99th percentile. In contrast, applying a pediatric sex-specific 97.5th percentile would identify 2261 (23.0% [95% CI, 22.2%\u201323.8%]) with myocardial injury (a 28% relative increase). Infants had a higher frequency of myocardial injury than those 1\u201318 years old (1035\/1104; 93.8% [95% CI, 92.2%\u201395.1%] vs 1226\/8729; 14.0% [95% CI, 13.3%\u201314.8%] using pediatric sex-specific 97.5th percentile, P &amp;lt; 0.001). Testing for cTn increased over the study period (\u03c4 = 0.42, P &amp;lt; 0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The use of pediatric-specific 97.5th percentile URLs for cTn would increase classification of myocardial injury in children and young adults. The clinical implications of this are uncertain and require further study given cTn testing has increased over the last decade.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jalm\/jfaf205","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T13:04:41Z","timestamp":1765544681000},"page":"554-568","source":"Crossref","is-referenced-by-count":3,"title":["Cardiac Troponin Thresholds in Children and Young Adults: A Multi-Center Cohort Study"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1024-7651","authenticated-orcid":false,"given":"Alexander J F","family":"Thurston","sequence":"first","affiliation":[{"name":"BHF Centre for Cardiovascular Science, The University of Edinburgh , Edinburgh ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eirik \u00c5","family":"R\u00f8ys","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, University of Bergen , Bergen ,","place":["Norway"]},{"name":"Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital , Bergen ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ragnhild","family":"R\u00f8ysland","sequence":"additional","affiliation":[{"name":"Multidisciplinary Laboratory Medicine and Medical Biochemistry, Division of Diagnostics and Technology, Akershus University Hospital , L\u00f8renskog ,","place":["Norway"]},{"name":"Institute of Clinical Medicine, Faculty of Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d8yvind","family":"Skadberg","sequence":"additional","affiliation":[{"name":"Laboratory of Medical Biochemistry, Stavanger University Hospital , Stavanger ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabienne","family":"Decrue","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science, The University of Edinburgh , Edinburgh ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1591-1352","authenticated-orcid":false,"given":"Dorien M","family":"Kimenai","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science, The University of Edinburgh , Edinburgh ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0533-7991","authenticated-orcid":false,"given":"Nicholas L","family":"Mills","sequence":"additional","affiliation":[{"name":"BHF Centre for Cardiovascular Science, The University of Edinburgh , Edinburgh ,","place":["United Kingdom"]},{"name":"Usher Institute, University of Edinburgh , Edinburgh ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7340-6736","authenticated-orcid":false,"given":"Kristin M","family":"Aakre","sequence":"additional","affiliation":[{"name":"Department of Clinical Science, University of Bergen , Bergen ,","place":["Norway"]},{"name":"Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital , Bergen ,","place":["Norway"]},{"name":"Department of Heart Disease, Haukeland University Hospital , Bergen ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"2026050509521069500_jfaf205-B1","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1016\/0022-2828(89)90680-9","article-title":"Enzyme linked immuno assay of cardiac troponin T for the detection of acute myocardial infarction in patients","volume":"21","author":"Katus","year":"1989","journal-title":"J Mol Cell Cardiol"},{"key":"2026050509521069500_jfaf205-B2","doi-asserted-by":"crossref","first-page":"e618","DOI":"10.1161\/CIR.0000000000000617","article-title":"Fourth 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