title: Serum Cardiac Troponin I in the Evaluation of Nonaccidental Trauma.
abstract: OBJECTIVE
  To determine if troponin I is more often elevated in children with suspected nonaccidental trauma (NAT) compared with uninjured children of similar age, and describe associations between troponin I elevation and NAT injuries.
  
  
  METHODS
  Prospective 2-group study of children less than 2 years of age presenting to the emergency department with nonaccidental abdominal, thoracic, or intracranial injuries, and similarly aged uninjured children. Primary outcome was serum troponin I (≥ 0.04 ng/mL) using frozen blood samples from the 2 groups. Secondary outcomes included descriptive analyses of age, injury characteristics, and clinical appearance.
  
  
  RESULTS
  There were 129 subjects; 60 injured patients and 69 uninjured patients. Groups had similar age and sex. Troponin I was elevated in 38% of injured children compared with 17% of uninjured children (P = .008). No uninjured patient over 3 months of age had elevated troponin I. Abdominal trauma, acute rib fractures, or the child's ill-appearance in the emergency department were associated with having elevated troponin I.
  
  
  CONCLUSIONS
  Troponin I is more often elevated in children with suspected NAT than uninjured children. Elevation of troponin I in children greater than 3 months of age with suspected NAT is concerning for trauma. Occult cardiac injury is more likely to occur in children with inflicted abdominal trauma, acute rib fractures, or ill appearance.
authors.affiliation: Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH. Electronic address: Berkeley.Bennett@cchmc.org.
authors.forename: Berkeley L
authors.initials: BL
authors.lastname: Bennett
authors.affiliation: Clinical Laboratory, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Paul
authors.initials: P
authors.lastname: Steele
authors.affiliation: Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH; Center for Global Health, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Cinnamon A
authors.initials: CA
authors.lastname: Dixon
authors.affiliation: Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: E Melinda
authors.initials: EM
authors.lastname: Mahabee-Gittens
authors.affiliation: Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Jarrod
authors.initials: J
authors.lastname: Peebles
authors.affiliation: Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Kimberly W
authors.initials: KW
authors.lastname: Hart
authors.affiliation: Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Lindsell
authors.affiliation: Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Chua
authors.affiliation: Division of Cardiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Russel
authors.initials: R
authors.lastname: Hirsh
mesh_terms: D015415:Biomarkers / Q000097:blood; D002649:Child Abuse / Q000706:statistics & numerical data*; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D019210:Troponin I / Q000097:blood*; D014947:Wounds and Injuries / Q000097:blood*
chemical_list: D015415:Biomarkers; D019210:Troponin I