J Emerg Nurs. 2022 Nov;48(6):678-687.e1. doi: 10.1016/j.jen.2022.07.002. Epub 2022 Aug 19.
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.
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).
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.
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.
在儿童中，可能会进行专门的实验室评估来诊断室上性心动过速，但其实用性尚不清楚。本研究的目的是评估新诊断为室上性心动过速的儿科患者进行专门实验室检查的类型、频率和结果。我们假设，当进行专门的实验室检查时（特别是针对心力衰竭、毒理学、炎症和甲状腺疾病），结果通常在正常范围内。
这是一项使用电子病历数据库（TriNetX，Inc.）的回顾性描述性研究。我们收集并评估了以下数据：年龄小于 18 岁且首次诊断为室上性心动过速的患者的人口统计学数据、诊断代码、死亡和实验室代码/结果（B 型利钠肽、B 型利钠肽前体 N 端、肌钙蛋白 I、毒理学检查、炎症标志物和甲状腺研究）。
共纳入 621 例患者（524 例[84.4%]无实验室检查，97 例[15.6%]有实验室检查）。甲状腺研究（65 例[10.5%]）是最常见的实验室检查，其次是心血管特异性研究（35 例[5.6%]）、炎症标志物（21 例[3.4%]）和毒理学检查（10 例[1.6%]）（P<.002）。年龄较大、女性以及需要紧急、住院和重症监护服务的患者更常进行实验室检查。
患有室上性心动过速的儿科患者常进行心脏特异性和非心脏特异性实验室检查。甲状腺研究是最常见的实验室检查，但异常结果仅出现在不到四分之一的患者中。这些发现可能突出了一个质量改进的机会，为急诊护士和从业者在进行实验室检查时提供了更好地为这一脆弱人群提供基于证据的高价值护理的机会。
