{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T13:06:48Z","timestamp":1770296808580,"version":"3.49.0"},"reference-count":20,"publisher":"American Academy of Pediatrics (AAP)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,6,1]]},"abstract":"<jats:sec>\n                  <jats:title>BACKGROUND:<\/jats:title>\n                  <jats:p>The clinical spectrum of pediatric acute myocarditis ranges from minimal symptoms with intact hemodynamics to rapid cardiovascular collapse and death. We sought to identify factors on initial presentation associated with subsequent hemodynamic compromise.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS:<\/jats:title>\n                  <jats:p>We performed a retrospective cohort study of patients with acute myocarditis at a freestanding pediatric hospital from 2007 to 2016. We defined 2 cohorts: high-acuity patients with hemodynamic compromise defined as requiring inotropic or vasoactive medications, cardiopulmonary resuscitation, extracorporeal membrane oxygenation, ventricular assist devices, or transplant or who died and low-acuity patients without these interventions. We collected the first recorded set of vital signs, symptoms, laboratory values, and chest radiograph, electrocardiogram, and echocardiography results. Univariate analysis was performed, and 2 multivariable logistic regression models were created to discriminate between cohorts.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS:<\/jats:title>\n                  <jats:p>A total of 74 patients were included: 33 high acuity and 41 low acuity. There were significant differences in demographics, symptoms, and physical examination, laboratory, electrocardiogram, and echocardiography findings between high- and low-acuity cohorts. Multivariable logistic regression models were highly discriminate in predicting those in the high-acuity cohort. The first model included presence of tachycardia, tachypnea, creatinine, and cardiomegaly on chest radiograph (area under the curve = 0.913). The second model added the presence of pericardial effusion to the above variables (area under the curve = 0.964).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS:<\/jats:title>\n                  <jats:p>Models based on factors available at initial presentation with acute myocarditis are predictive of subsequent hemodynamic compromise. If our results can be validated in a multicenter study, these models may help disposition patients with suspected acute myocarditis (with those who meet model criteria being admitted to centers capable of rapidly providing extracorporeal membrane oxygenation, ventricular assist devices, and heart transplant evaluation).<\/jats:p>\n               <\/jats:sec>","DOI":"10.1542\/hpeds.2018-0212","type":"journal-article","created":{"date-parts":[[2019,5,31]],"date-time":"2019-05-31T13:25:24Z","timestamp":1559309124000},"page":"455-459","source":"Crossref","is-referenced-by-count":6,"title":["Pediatric Acute Myocarditis: Predicting Hemodynamic Compromise at Presentation to Health Care"],"prefix":"10.1542","volume":"9","author":[{"given":"Ashley E.","family":"Wolf","sequence":"first","affiliation":[{"name":"Division of Critical Care Medicine, Seattle Children\u2019s Hospital, Seattle, Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley S.","family":"Marino","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Feinberg School of Medicine and"},{"name":"Divisions of Critical Care and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad Sami","family":"Chaouki","sequence":"additional","affiliation":[{"name":"Cardiology, Ann & Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, Illinois; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adin-Cristian","family":"Andrei","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Northwestern University, Chicago, Illinois"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey G.","family":"Gossett","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of California, San Francisco Benioff Children\u2019s Hospital, San Francisco, California"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2019,6,1]]},"reference":[{"issue":"3","key":"2021120817083878700_B1","doi-asserted-by":"crossref","first-page":"346","DOI":"10.1097\/PEC.0b013e3182852f86","article-title":"Diagnostic evaluation of pediatric myocarditis in the emergency department: a 10-year case series in the Asian population","volume":"29","author":"Shu-Ling","year":"2013","journal-title":"Pediatr Emerg Care"},{"issue":"8","key":"2021120817083878700_B2","doi-asserted-by":"crossref","first-page":"942","DOI":"10.1016\/j.ajem.2008.07.032","article-title":"Pediatric myocarditis: presenting clinical characteristics","volume":"27","author":"Durani","year":"2009","journal-title":"Am J Emerg Med"},{"issue":"15","key":"2021120817083878700_B3","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1161\/CIRCULATIONAHA.105.606509","article-title":"Presentation, patterns of myocardial damage, and clinical course of viral myocarditis","volume":"114","author":"Mahrholdt","year":"2006","journal-title":"Circulation"},{"issue":"9","key":"2021120817083878700_B4","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/j.jacc.2011.09.074","article-title":"Update on myocarditis","volume":"59","author":"Kindermann","year":"2012","journal-title":"J Am Coll Cardiol"},{"issue":"3","key":"2021120817083878700_B5","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1016\/S0735-1097(03)00648-X","article-title":"Detection of viruses in myocardial tissues by polymerase chain reaction. 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