{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T21:38:38Z","timestamp":1791581918299,"version":"4.3.4"},"reference-count":50,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2023,7,4]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Myocardial injury is an important pediatric diagnosis. Establishing normative data from a representative pediatric sample is vital to provide accurate upper reference limits (URLs) for defining myocardial injury using high-sensitivity cardiac troponin.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Among participants 1 to 18 years of age in the 1999\u20132004 National Health and Nutrition Examination Survey, we measured high-sensitivity troponin T using one assay (Roche) and high-sensitivity troponin I using 3 assays (Abbott, Siemens, and Ortho). In a strictly defined healthy subgroup, we estimated 97.5th and 99th percentile URLs for each assay using the recommended nonparametric method.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>Of 5695 pediatric participants, 4029 met criteria for the healthy subgroup (50% males; mean age 12.6 years). Our 99th percentile URL estimates for all 4 high-sensitivity troponin assays among children and adolescents were lower than the manufacturer-reported URLs (derived from adults). The 99th percentile URLs (95% CI) were 15 ng\/L (95% CI, 12\u201317) for high-sensitivity troponin T, 16 ng\/L (95% CI, 12\u201319) for high-sensitivity troponin I with the Abbott assay, 38 ng\/L (95% CI, 25\u201346) for high-sensitivity troponin I with the Siemens assay, and 7 ng\/L (95% CI, 5, 12) for high-sensitivity troponin I with the Ortho assay. The 95% CIs for age-, sex-, and race and ethnicity-specific 99th percentile URLs overlapped. However, the 97.5th percentile URL for each assay was measured with superior statistical precision (ie, tighter 95% CIs) and demonstrated differences by sex. For male compared with female children and adolescents, 97.5th percentile URLs were 11 ng\/L (95% CI, 10\u201312) versus 6 ng\/L (95% CI, 6\u20137) for high-sensitivity troponin T, 9 ng\/L (95% CI, 7\u201310) versus 5 ng\/L (95% CI, 4\u20136) for high-sensitivity troponin I with the Abbott assay, 21 ng\/L (95% CI, 18\u201325) versus 11 ng\/L (95% CI, 9\u201313) for high-sensitivity troponin I with the Siemens assay, and 4 ng\/L (95% CI, 3\u20135) versus 2 ng\/L (95% CI, 1\u20133) for high-sensitivity troponin I with the Ortho assay. In contrast to the 99th percentiles, the point estimates of 97.5th percentile pediatric URLs for high-sensitivity troponin were also much more stable to differences in the analytic approaches taken to estimate URLs.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Because myocardial infarction is rare in children and adolescents, the use of statistically more precise and reliable sex-specific 97.5th percentile high-sensitivity troponin URLs might be considered to define pediatric myocardial injury.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circulationaha.122.063281","type":"journal-article","created":{"date-parts":[[2023,4,20]],"date-time":"2023-04-20T09:22:35Z","timestamp":1681982555000},"page":"7-16","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":26,"title":["Myocardial Injury Thresholds for 4 High-Sensitivity Troponin Assays in a Population-Based Sample of US Children and Adolescents"],"prefix":"10.1161","volume":"148","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6530-5479","authenticated-orcid":true,"given":"John W.","family":"McEvoy","sequence":"first","affiliation":[{"name":"Division of Cardiology and National Institute for Prevention &amp; Cardiovascular Health, University of Galway, Ireland (J.W.M.)."},{"name":"Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M. D.W., C.E.N., J.C., E.S.)."},{"name":"Johns Hopkins School of Medicine (J.W.M. O.T., C.E.N.), Johns Hopkins University, Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M. D.W., C.E.N., J.C., E.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1315-6747","authenticated-orcid":true,"given":"Tammy","family":"Brady","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Pediatrics (T.B.), Johns Hopkins University, Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8075-1298","authenticated-orcid":true,"given":"Olive","family":"Tang","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Medicine (J.W.M. O.T., C.E.N.), Johns Hopkins University, Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1603-282X","authenticated-orcid":true,"given":"Chiadi E.","family":"Ndumele","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M. D.W., C.E.N., J.C., E.S.)."},{"name":"Johns Hopkins School of Medicine (J.W.M. O.T., C.E.N.), Johns Hopkins University, Baltimore, MD."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4598-0669","authenticated-orcid":true,"given":"Josef","family":"Coresh","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (J.W.M. 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