Clinical Presentation, Prognostic Factors, and Outcomes of Pediatric patients Diagnosed with Acute Myocarditis: A 10-Year Experience from the Emergency Department of a Tertiary Care Hospital.

Abstract

Background: Myocarditis is a rare inflammatory disease of the myocardium with an annual incidence of 1 to 2 per 100,000 children. Patients with myocarditis present with variable signs and symptoms ranging from subclinical disease to arrhythmia, heart failure, and sudden cardiac arrest. This study is aimed to determine the clinical presentations and outcome of children diagnosed with acute myocarditis in the emergency department of a tertiary care hospital. Methods: This single center cross-sectional study was conducted in the emergency department of the Aga Khan University Hospital from January 2005 to December 2015. All children from six months to sixteen years of either gender admitted with a probable or definitive diagnosis of acute myocarditis from the emergency department were included. All the data were entered and analyzed on SPSS v20. The continuous variables were expressed as mean +/- SD and frequencies, and percentages were computed for categorical data. Univariate and multivariate analysis was done with a p-value of less than 0.05 was considered significant. Results: A total of 52 children were diagnosed with myocarditis during the study period. The mean age was 34.33 months with slightly higher preponderance of females (52%). More than half of the patients had a history of upper respiratory infection. The most common presenting symptoms were shortness of breath (46%), followed by irritability and drowsiness (38%). Forty-seven patients (90%) needed inotropic support and 33 patients (63%) required ventilatory support during hospital stay. Thirteen patients (25%) expired during hospital stay. Conclusion: Myocarditis in pediatric patients has higher mortality and may present with acute onset of symptoms that may be vague and overlapping. Early identification and prompt management by experienced pediatric emergency physicians may reduce morbidity and mortality.