Prevalence of myocarditis in pediatric intensive care unit cases presenting with other system involvement^☆ ☆ Please cite this article as: Rady HI, Zekri H. Prevalence of myocarditis in pediatric intensive care unit cases presenting with other system involvement. J Pediatr (Rio J). 2015;91:93-7. ^☆☆ ☆☆ The study was conducted on PICU, New Children's Hospital, Cairo University, Cairo, Egypt.

OBJECTIVE:

To assess children with myocarditis, the frequency of various presenting symptoms, and the accuracy of different investigations in the diagnosis.

METHODS:

This was an observational study of 63 patients admitted to PICU with non-cardiac diagnosis. Cardiac enzymes, chest-X ray, echocardiography, and electrocardiogram were performed to diagnose myocarditis among those patients.

RESULTS:

There were 16 cases of definite myocarditis. The age distribution was non-normal, with median of 5.5 months (3.25-21). Of the 16 patients who were diagnosed with myocarditis, 62.5% were originally diagnosed as having respiratory problems, and there were more females than males. Among the present cases, the accuracy of cardiac enzymes (cardiac troponin T [cTn] and creatine phosphokinase MB [CKMB]) in the diagnosis of myocarditis was only 63.5%, while the accuracy of low fractional shortening and of chest-X ray cardiomegaly was 85.7 and 80.9%; respectively. Cardiac troponin folds 2.02 had positive predictive value of 100%, negative predictive value of 88.7%, specificity of 100%, sensitivity of 62.5%, and accuracy of 90.5%.

CONCLUSIONS:

Children with myocarditis present with symptoms that can be mistaken for other types of illnesses. When clinical suspicion of myocarditis exists, chest-X ray and echocardiography are sufficient as screening tests. Cardiac troponins confirm the diagnosis in screened cases, with specificity of 100%.

Myocarditis; Cardiac enzymes; Troponin; Children; Pediatric intensive care unit