ArticleBMJ paediatrics open2026
Transthoracic echocardiography in children with
Article in BMJ paediatrics open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
background
methodsThis multi-centre retrospective cohort study included 101 children (aged ≤18 years) with SAB across six North West London hospitals (2018-2023). Data were collected from electronic patient records.
results71 children (70%) underwent TTE and 30 (30%) did not. IE was confirmed in four (5.6%) of those undergoing TTE. All four IE cases were right-sided and occurred in children with established risk factors: congenital heart disease (2/4), intravenous drug use (1/4) or central venous catheters (2/4). The TTE group had longer hospital stays than the no-TTE group (median 17 vs 4 days, p=0.0020). Acute in-hospital mortality occurred in 1/71 of the TTE group vs 0/30 of the no-TTE group (p=1.0). Among children undergoing TTE, features associated with IE included embolic phenomena (75% vs 1.5%, p<0.001), higher CRP (median 237 vs 124 mg/L, p=0.083), persistent bacteraemia at >72 hours (67% vs 4.9%, p=0.018) and polymicrobial growth on blood culture (50% vs 6%, p=0.033).
conclusionOur findings support a risk-stratified rather than universal approach to TTE in paediatric SAB. TTE could reasonably be omitted in children with a structurally normal heart, no established IE risk factor and no clinical feature suggestive of IE, but should be performed when embolic phenomena, persistent bacteraemia, polymicrobial growth, a pre-existing murmur or an established IE risk factor is present. Prospective multi-centre validation is needed before such an approach can be adopted in routine practice.
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