Abstract 15996: Pediatric Acute Myocarditis: Predicting Hemodynamic Compromise at Presentation to Healthcare
Introduction: The spectrum of pediatric myocarditis ranges from minimal symptoms with intact hemodynamics to rapid collapse and death; appropriate triage is critical. We sought to identify vital signs, symptoms, and tests at initial presentation predicting subsequent hemodynamic compromise.
Methods: Retrospective case series of pts 1d to 18 yrs old diagnosed with myocarditis at Lurie Children’s from 2007-16. Two cohorts were defined: high-acuity (HA): all pts requiring ionotropes, CPR, ECMO, VAD, transplant, or who died; low-acuity (LA): all pts without these interventions. The first recorded set of vital signs, symptoms, laboratory values, CXR, ECG, and ECHO findings were collected if obtained within 24 hours of presentation. Univariate analysis was performed and two multivariable logistic regression (LR) models were created to discriminate between cohorts, evaluated based on the area under the receiver’s operating characteristics curve (AUC) and internally cross-validated. A “non-quaternary” model included tachycardia, tachypnea, creatinine, and cardiomegaly, and a “quaternary” model, for use when ECHO is available, added presence of a pericardial effusion.
Results: Of 74 pts, 41 were LA and 33 HA. HA pts were more likely to be younger, weigh less, be female, have shortness of breath, or GI symptoms, but less likely to have chest pain. HA pts were more likely to be tachycardic, tachypneic, hypotensive, and hypoxemic and to have wheezing, gallop, hepatomegaly, and abnormal perfusion or pulses. HA pts were more likely to have abnormal hemoglobin, albumin, ALT, pH, bicarbonate, BNP, creatinine, cardiomegaly and pulmonary edema on CXR, and bundle branch block on ECG. HA pts were more likely to have pericardial effusion, mitral regurgitation, and lower ejection and shortening fractions on ECHO. Troponin level was not different between cohorts. Non-quaternary LR model showed an AUC = 0.913. Quaternary LR model had an AUC = 0.964.
Conclusions: Factors at initial presentation with myocarditis are associated with later hemodynamic compromise. Our two internally-validated models based on initial vital signs, symptoms, and laboratory data predict the need for ICU care and can be used to appropriately disposition patients who may deteriorate rapidly.
Author Disclosures: A.E. Wolf: None. A.S. Chaouki: None. B.S. Marino: None. A. Andrei: None. J.G. Gossett: None.
- © 2016 by American Heart Association, Inc.