Advertisement

A Multicenter Retrospective Evaluation of Specialized Laboratory Investigations in the Workup of Pediatric Patients With New-Onset Supraventricular Tachycardia

Published:August 18, 2022DOI:https://doi.org/10.1016/j.jen.2022.07.002

      Abstract

      Introduction

      Specialized laboratory evaluation of supraventricular tachycardia in children may occur, but the utility is unknown. The study objectives are to assess the type, frequency, and results of specialized laboratory testing performed in pediatric patients presenting with new-onset supraventricular tachycardia. We hypothesized that when specialized laboratory testing occurs (particularly for cardiac failure, toxicologic, inflammatory, and thyroid diseases), the results are generally within normal limits.

      Methods

      This is a retrospective descriptive study using an electronic health record database (TriNetX, Inc). We collected and evaluated the following data of subjects aged younger than 18 years with a first-time supraventricular tachycardia diagnosis: demographics, diagnostic codes, deaths, and laboratory codes/results (natriuretic peptide B, natriuretic peptide B prohormone N-terminal, troponin I, toxicology testing, inflammatory markers, and thyroid studies).

      Results

      A total of 621 subjects (524 [84.4%] without laboratory testing, 97 [15.6%] with laboratory testing) were included. Thyroid studies (65 [10.5%]) were the most frequent laboratory study performed followed by cardiovascular specific studies (35 [5.6%]), inflammatory markers (21 [3.4%]), and toxicology tests (10 [1.6%]) (P = .002). Obtained laboratory testing was more frequent with older subjects, females, and need for emergency, hospital, and critical care services.

      Discussion

      Cardiac-specific and noncardiac laboratory testing is frequently ordered for pediatric patients who present with supraventricular tachycardia. Thyroid studies were the most common laboratory testing ordered, but abnormal results only occurred in less than a quarter of subjects. These findings may highlight a quality improvement opportunity for emergency nurses and practitioners in the practice of obtaining laboratory tests to better reflect high-value evidence-based care for this vulnerable population.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Emergency Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sekar R.P.
        Epidemiology of arrhythmias in children.
        Indian Pacing Electrophysiol J. 2008; 8: S8-S13
        • Turner C.J.
        • Wren C.
        The epidemiology of arrhythmia in infants: a population-based study.
        J Paediatr Child Health. 2013; 49: 278-281https://doi.org/10.1111/jpc.12155
        • Lutfi R.
        • Montgomery E.E.
        • Berrens Z.J.
        • et al.
        Improving adherence to a pediatric advanced life support supraventricular tachycardia algorithm in community emergency departments following in situ simulation.
        J Contin Educ Nurs. 2019; 50: 404-410https://doi.org/10.3928/00220124-20190814-06
        • Moore A.
        • Nelson C.
        • Molins C.
        • Mead P.
        • Schriefer M.
        Current guidelines, common clinical pitfalls, and future directions for laboratory diagnosis of lyme disease, United States.
        Emerg Infect Dis. 2016; 22https://doi.org/10.3201/eid2207.151694
        • Green E.H.
        • Hershman W.
        • DeCherrie L.
        • Greenwald J.
        • Torres-Finnerty N.
        • Wahi-Gururaj S.
        Developing and implementing universal guidelines for oral patient presentation skills.
        Teach Learn Med. 2005; 17: 263-267https://doi.org/10.1207/s15328015tlm1703_11
        • Mahtani A.U.
        • Nair D.G.
        Supraventricular tachycardia.
        Med Clin North Am. 2019; 103: 863-879https://doi.org/10.1016/j.mcna.2019.05.007
        • Hanash C.R.
        • Crosson J.E.
        Emergency diagnosis and management of pediatric arrhythmias.
        J Emerg Trauma Shock. 2010; 3: 251-260https://doi.org/10.4103/0974-2700.66525
        • Vignati G.
        Pediatric arrhythmias: which are the news?.
        J Cardiovasc Med (Hagerstown). 2007; 8: 62-66https://doi.org/10.2459/01.JCM.0000247438.12817.9e
        • Helton M.R.
        Diagnosis and management of common types of supraventricular tachycardia.
        Am Fam Phys. 2015; 92: 793-800
        • Lewis J.
        • Arora G.
        • Tudorascu D.L.
        • Hickey R.W.
        • Saladino R.A.
        • Manole M.D.
        Acute management of refractory and unstable pediatric supraventricular tachycardia.
        J Pediatr. 2017; 181: 177-182.e2https://doi.org/10.1016/j.jpeds.2016.10.051
        • Harrison S.L.
        • Fazio-Eynullayeva E.
        • Lane D.A.
        • Underhill P.
        • Lip G.Y.H.
        Atrial fibrillation and the risk of 30-day incident thromboembolic events, and mortality in adults ≥ 50 years with COVID-19.
        J Arrhythm. 2021; 37: 231-237https://doi.org/10.1002/joa3.12458
        • Osman F.
        • Gammage M.D.
        • Sheppard M.C.
        • Franklyn J.A.
        Clinical review 142: cardiac dysrhythmias and thyroid dysfunction: the hidden menace?.
        J Clin Endocrinol Metab. 2002; 87: 963-967https://doi.org/10.1210/jcem.87.3.8217
        • Dominic P.
        • Ahmad J.
        • Awwab H.
        • et al.
        Stimulant drugs of abuse and cardiac arrhythmias.
        Circ Arrhythm Electrophysiol. 2022; 15e010273https://doi.org/10.1161/CIRCEP.121.010273
        • Lapoint J.
        • James L.P.
        • Moran C.L.
        • Nelson L.S.
        • Hoffman R.S.
        • Moran J.H.
        Severe toxicity following synthetic cannabinoid ingestion.
        Clin Toxicol (Phila). 2011; 49: 760-764https://doi.org/10.3109/15563650.2011.609822
        • Pandya M.
        • Garcia R.A.
        • Awori J.
        Thyrotoxicosis in a pediatric patient with supraventricular tachycardia and borderline features of thyroid storm.
        AACE Clin Case Rep. 2019; 5: e393-e395https://doi.org/10.4158/ACCR-2019-0261
        • Léger J.
        • Carel J.C.
        Hyperthyroidism in childhood: causes, when and how to treat.
        J Clin Res Pediatr Endocrinol. 2013; 5: 50-56https://doi.org/10.4274/jcrpe.854
        • Sawin C.T.
        • Geller A.
        • Wolf P.A.
        • et al.
        Low serum thyrotropin concentrations as a risk factor for atrial fibrillation in older persons.
        N Engl J Med. 1994; 331 (https://doi.org/10.1056/NEJM199411103311901): 1249-1252
        • Kluesner J.K.
        • Beckman D.J.
        • Tate J.M.
        • et al.
        Analysis of current thyroid function test ordering practices.
        J Eval Clin Pract. 2018; 24: 347-352https://doi.org/10.1111/jep.12846
        • Yoldaş T.
        • Örün U.A.
        What is the significance of elevated troponin I in children and adolescents? A diagnostic approach.
        Pediatr Cardiol. 2019; 40: 1638-1644https://doi.org/10.1007/s00246-019-98-w
        • Ashok A.
        • Cabalag M.
        • Taylor D.M.
        Usefulness of laboratory and radiological investigations in the management of supraventricular tachycardia.
        Emerg Med Australas. 2017; 29: 394-399https://doi.org/10.1111/1742-6723.12766
        • Fernando H.
        • Adams N.
        • Mitra B.
        Review article: the utility of troponin and other investigations in patients presenting to the emergency department with supraventricular tachycardia.
        Emerg Med Australas. 2019; 31: 35-42https://doi.org/10.1111/1742-6723.12971
        • Schiff G.D.
        • Martin S.A.
        • Eidelman D.H.
        • et al.
        Ten principles for more conservative, care-full diagnosis.
        Ann Intern Med. 2018; 169: 643-645https://doi.org/10.7326/M18-1468
        • Eldridge D.L.
        Alternatives to intravenous rehydration in dehydrated pediatric patients with difficult venous access.
        Pediatr Emerg Care. 2010; 26: 529-535https://doi.org/10.1097/PEC.0b013e3181e5c00e
        • Branco B.C.
        • Inaba K.
        • Doughty R.
        • et al.
        The increasing burden of phlebotomy in the development of anaemia and need for blood transfusion amongst trauma patients.
        Injury. 2012; 43: 78-83https://doi.org/10.1016/j.injury.2010.12.003
        • Jefferson B.K.
        • King J.E.
        Impact of the acute care nurse practitioner in reducing the number of unwarranted daily laboratory tests in the intensive care unit.
        J Am Assoc Nurse Pract. 2018; 30: 285-292https://doi.org/10.1097/JXX.0000000000000050

      Biography

      Kodi M. Endres is Medical Student, Penn State College of Medicine, Hershey, PA. ORCID identifier: https://orcid.org/0000-0001-6110-4266.

      Biography

      Krista Kierys is Pediatric Critical Care Medicine Nurse Practitioner, Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children’s Hospital, Hershey, PA.

      Biography

      Yimeng Shang is PhD Student of Biostatistics, Department of Public Health Sciences; and Division of Biostatistics and Bioinformatics, Pennsylvania State University College of Medicine, Hershey, PA.

      Biography

      Shouhao Zhou is Biostatistician, Department of Public Health Sciences; and Division of Biostatistics and Bioinformatics, Pennsylvania State University College of Medicine, Hershey, PA.

      Biography

      Gary D. Ceneviva is Pediatric Critical Care Physician, Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children’s Hospital, Hershey, PA. ORCID identifier: https://orcid.org/0000-0003-4572-8620.

      Biography

      Neal J. Thomas is Pediatric Critical Care Physician, Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children’s Hospital; Department of Public Health Sciences; and Division of Biostatistics and Bioinformatics, Pennsylvania State University College of Medicine, Hershey, PA. ORCID identifier: https://orcid.org/0000-0002-7991-7510.

      Biography

      Conrad Krawiec is Pediatric Critical Care Physician, Pediatric Critical Care Medicine, Department of Pediatrics, Penn State Hershey Children’s Hospital, Hershey, PA. Twitter: ckrawiec4 . ORCID identifier: https://orcid.org/0000-0001-7902-2568.