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

• Published in: Journal of emergency nursing Vol. 48; no. 6; pp. 678 - 687.e1
• Main Authors: Endres, Kodi M., Kierys, Krista, Shang, Yimeng, Zhou, Shouhao, Ceneviva, Gary D., Thomas, Neal J., Krawiec, Conrad
• Format: Journal Article
• Language: English
• Published: Philadelphia Elsevier Inc 01.11.2022; Elsevier Limited
• Subjects: Accountability; Age; Cardiac arrhythmia; Cardiac dysrhythmias; Codes; Critical care; Electronic health records; Emergency medical care; Emergency services; Health insurance; Heart failure; ISO standards; Laboratories; Laboratory examinations and diagnoses; Medical diagnosis; Nurses; Patients; Pediatrics; Peptides; Proteins; Quality management; Regression analysis; Supraventricular tachycardia; Thyroid gland; Toxicology; Vulnerability; Pediatrics; Laboratory examinations and diagnoses; Supraventricular tachycardia; Cardiac dysrhythmias
• ISSN: 0099-1767; 1527-2966; 1527-2966
• DOI: 10.1016/j.jen.2022.07.002

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.