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Alsabri M, Elshanbary AA, Nourelden AZ, Fathallah AH, Zaazouee MS, Pincay J, Nakadar Z, Wasem M, Aeder L. Chest pain in pediatric patients in the emergency department- Presentation, risk factors and outcomes-A systematic review and meta-analysis. PLoS One 2024; 19:e0294461. [PMID: 38626180 PMCID: PMC11020527 DOI: 10.1371/journal.pone.0294461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/31/2023] [Indexed: 04/18/2024] Open
Abstract
OBJECTIVE This study aimed to assess and determine the presentation, risk factors, and outcomes of pediatric patients who were admitted for cardiac-related chest pain. BACKGROUND Although chest pain is common in children, most cases are due to non-cardiac etiology. The risk of misdiagnosis and the pressure of potentially adverse outcomes can lead to unnecessary diagnostic testing and overall poorer patient experiences. Additionally, this can lead to a depletion of resources that could be better allocated towards patients who are truly suffering from cardiac-related pathology. METHODS This review was conducted per PRISMA guidelines. This systematic review used several databases including MEDLINE, Embase, Scopus, and Web of Science to obtain its articles for review. RESULTS A total of 6,520 articles were identified, and 11 articles were included in the study. 2.5% of our study population was found to have cardiac-related chest pain (prevalence = 0.025, 95% CI [0.013, 0.038]). The most commonly reported location of pain was retrosternal chest pain. 97.5% of the study population had a non-cardiac cause of chest pain, with musculoskeletal pain being identified as the most common cause (prevalence = 0.357, 95% CI [0.202, 0.512]), followed by idiopathic (prevalence = 0.352, 95% CI [0.258, 0.446]) and then gastrointestinal causes (prevalence = 0.053, 95% CI [0.039, 0.067]). CONCLUSIONS The overwhelming majority of pediatric chest pain cases stem from benign origins. This comprehensive analysis found musculoskeletal pain as the predominant culprit behind chest discomfort in children. Scrutinizing our study cohort revealed that retrosternal chest pain stands as the unequivocal epicenter of this affliction. Thorough evaluation of pediatric patients manifesting with chest pain is paramount for the delivery of unparalleled care, especially in the context of potential cardiac risks in the emergency department.
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Affiliation(s)
- Mohammed Alsabri
- Department of Pediatrics/Emergency Pediatrics, Althawra Modern General Hospital, Sana’a, Yemen
| | | | | | | | | | - Jorge Pincay
- SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
| | - Zaid Nakadar
- SUNY Downstate Health Sciences University, Brooklyn, NY, United States of America
| | - Muhammad Wasem
- Pediatric Emergency Department NYC Health + Hospitals/Lincoln, Bronx, NY, United States of America
| | - Lita Aeder
- Pediatric Department, Brookdale Hospital, Brooklyn, NY, United States of America
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Alnaim AA, AlGarni HW, Al Ghadeer HA, Almulhim MA, Al Noaim KI, Al Ghamdi MA, Alahmari AA, Al Alawi ZH, Alabdulqader MA, Alghazal MM, Alhamad OY, AlEissa AE, AlAmer AT. Characteristics of chest pain among children presenting to the pediatric emergency department. J Med Life 2023; 16:1606-1610. [PMID: 38406783 PMCID: PMC10893581 DOI: 10.25122/jml-2023-0280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/25/2023] [Indexed: 02/27/2024] Open
Abstract
Chest pain in pediatric patients is a common concern in pediatric emergency departments (ED). In most cases, benign conditions are related to noncardiac causes, and only a minority of the cases are caused by heart disease. This research aimed to evaluate the causes and characteristics of chest pain among children in a pediatric emergency department. This retrospective study evaluated children younger than 14 years of age who presented to the emergency department of a general pediatric hospital in the Eastern area of Saudi Arabia with non-traumatic chest pain between 2017 and 2022. The data included socioeconomic information, physical examination findings, and the results of basic investigations, such as chest X-ray and electrocardiogram. The Chi-square test was performed to compare various etiologies, with a 5% significant level. The study evaluated 310 patients with a mean age of 9.1±2.7 years. The majority of children presenting with chest pain had normal physical examinations, except 3.3% who showed respiratory and cardiac findings. The diagnostic tests indicated pneumonia in 2.9% and arrhythmia in 2.1% of children. Most patients were discharged with a diagnosis of idiopathic or muscular chest pain. The majority of patients (95%) were treated symptomatically in outpatient settings, with just one patient requiring hospitalization. The most common cause of chest pain prompting a child to visit the ED was idiopathic chest pain. Therefore, this study highlights the significance of obtaining a comprehensive medical history and physical examination to reveal important clues and help avoid unnecessary tests.
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Affiliation(s)
| | - Hasna Wafi AlGarni
- Department of Pediatrics, Maternity and Children Hospital, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Hussain Adil Al Ghadeer
- Department of Pediatrics, Maternity and Children Hospital, AlAhsa Health Cluster, Saudi Arabia
| | | | | | - Mohammed Ahmad Al Ghamdi
- Department of Pediatrics, King Fahd Hospital, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulaziz Abdullah Alahmari
- Department of Pediatrics, King Fahd Hospital, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Zainab Hejji Al Alawi
- Department of Pediatrics, College of Medicine, King Faisal University, AlAhsa, Saudi Arabia
| | | | - Manal Mustafa Alghazal
- Department of Pediatrics, Maternity and Children Hospital, AlAhsa Health Cluster, Saudi Arabia
| | - Ohud Yousef Alhamad
- Department of Pediatrics, Maternity and Children Hospital, AlAhsa Health Cluster, Saudi Arabia
| | - Ahmed Eissa AlEissa
- Department of Pediatrics, Maternity and Children Hospital, AlAhsa Health Cluster, Saudi Arabia
| | - Ali Tawfiq AlAmer
- Department of Pediatrics, Maternity and Children Hospital, AlAhsa Health Cluster, Saudi Arabia
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Gumus YY, Senturk E. Anxiety, depressive, and somatoform disorders in children and adolescents referred to paediatric cardiology with somatic symptoms. Cardiol Young 2022; 33:1-6. [PMID: 35856274 DOI: 10.1017/s1047951122001949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Chest pain, palpitations, and syncope are among the most common referrals to paediatric cardiology. These symptoms generally have a non-cardiac aetiology in children and adolescents. The aim of this study was to investigate the rate of common psychiatric disorders in children and adolescents referred to the paediatric cardiology clinic with chest pain, palpitations, and syncope and the relationship between cardiological symptoms and psychiatric disorders. METHODS Children and adolescents aged 8-16 years who presented at the paediatric cardiology clinic with primary complaints of chest pain, palpitation, or syncope were included in the study. After a detailed cardiology examination, psychiatric disorders were assessed using the DSM IV-TR diagnostic criteria and a semi-structured interview scale (KSADS-PL). The Child Depression Inventory and Spielberger's State-Trait Anxiety Inventory for Children were also applied to assess the severity of anxiety and depression. RESULTS The study participants comprised 73 (68.90%) girls and 33 (31.10%) boys with a mean age of 12.5 ± 2.4 years. Psychiatric disorders were determined in a total of 48 (45.3%) participants; 24 (38.7%) in the chest pain group, 12 (48.0%) in the palpitation group, and 12 (63.2%) in the syncope group. Cardiological disease was detected in 17% of the cases, and the total frequencies of psychiatric disorders (p = 0.045) were higher in patients with cardiological disease. CONCLUSION It is clinically important to know that the frequency of psychiatric disorders is high in patients presenting at paediatric cardiology with chest pain, palpitations, and syncope. Physicians should be aware of patients' psychiatric problems and take a biopsychosocial approach in the evaluation of somatic symptoms.
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Affiliation(s)
- Yusuf Yasin Gumus
- Department of Child Psychiatry, Ondokuz Mayis University, Faculty of Medicine, Samsun, Turkey
| | - Ekrem Senturk
- Department of Child Psychiatry, Health Sciences University Derince Training and Research Hospital, Kocaeli, Turkey
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Chest pain in a pediatric emergency department: clinical assessment and management reality in a third-level Portuguese hospital. Porto Biomed J 2022; 7:e150. [PMID: 35801223 PMCID: PMC9257298 DOI: 10.1097/j.pbj.0000000000000150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 03/19/2021] [Indexed: 12/03/2022] Open
Abstract
Chest pain in children and adolescents is a common complaint in the emergency department (ED), being mostly benign. A thorough patient history and physical examination should be enough in most cases for its proper management. Regarding non-cardiac chest pain, anxiety plays an important role.
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Affiliation(s)
- Gal Barbut
- Maimonides Children's Hospital, Brooklyn, NY
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Abstract
OBJECTIVE To evaluate the impact of a pediatric emergency department (ED) chest pain clinical pathway on resource utilization. METHODS Motivated by perceived overuse of cardiology consultation for non-cardiac chest pain in the ED, clinicians from the Divisions of Cardiology and Emergency Medicine collaboratively developed a chest pain clinical pathway, educated staff, and implemented the pathway on March 1, 2014. We reviewed records of children aged 3 to 18 years without prior diagnoses of heart disease who presented to the ED with chest pain between March 1, 2013, and April 22, 2015. We compared diagnostic testing rates, ED length of stay, and cardiology consults before and after implementation of the pathway. RESULTS A total of 1687 patients were pathway eligible (675 patients preimplementation and 1012 postimplementation). Resource utilization was lower than expected before pathway implementation and remained low after implementation. There was a statistically significant reduction in rates of chest x-ray ordering after pathway implementation and ED length of stay but no change in other diagnostic testing or cardiology consultation. Follow-up in our health care system for pediatric chest pain increased from 15% to 29% with implementation, but none of these visits resulted in the diagnosis of a new cardiac condition. There were no instances identified where use of the pathway resulted in missed cardiac disease. CONCLUSIONS Implementation of a clinical pathway for pediatric chest pain did lead to a reduction in chest x-ray ordering in the ED and was associated with a higher rate of outpatient follow up for non-pathologic chest pain. Preimplementation utilization was lower than the prepathway perceptions of overuse suggested.
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Abstract
Pain is common in children presenting to emergency departments with episodic illnesses, acute injuries, and exacerbation of chronic disorders. We review recognition and assessment of pain in infants and children and discuss the manifestations of pain in children with chronic illness, recurrent pain syndromes, and cognitive impairment, including the difficulties of pain management in these patients. Non-pharmacological interventions, as adjuncts to pharmacological management for acute anxiety and pain, are described by age and development. We discuss the pharmacological management of acute pain and anxiety, reviewing invasive and non-invasive routes of administration, pharmacology, and adverse effects.
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Affiliation(s)
- Baruch S Krauss
- Division of Emergency Medicine, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
| | - Lorenzo Calligaris
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Steven M Green
- Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Egidio Barbi
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
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Chest pain in adolescent Japanese male mimicking acute coronary syndrome. Case Rep Crit Care 2014; 2014:176520. [PMID: 25202456 PMCID: PMC4151487 DOI: 10.1155/2014/176520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 07/17/2014] [Indexed: 11/30/2022] Open
Abstract
Acute chest pain with very elevated troponin level and abnormal EKG in adult population is considered sine qua non to acute coronary syndrome (ACS) unless proved otherwise. Similar presentation in adolescent population is seen less often but raises suspicion for ACS. Most common etiology for chest pain with cardiac enzyme elevation in adolescent population is usually viral myopericarditis. The adolescent population presenting with chest pain and elevated cardiac enzymes should be carefully evaluated for ACS and other etiologies including myocarditis, myopericarditis, pulmonary embolism, acute rheumatic fever, and trauma. We report one Japanese adolescent male with mycoplasma pneumoniae myocarditis who presented to the ER with chest pain, elevated cardiac enzymes, and abnormal EKG.
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Abstract
Acute chest pain with elevated troponin and CK-MB levels and focal ST elevation on electrocardiogram is considered to be myocardial infarction unless proven otherwise. The cardiac enzymes can be elevated in other etiologies of chest pain including myopericarditis, pulmonary embolism, acute rheumatic fever, and trauma. Therefore, patients presenting with chest pain and elevated cardiac enzymes should be carefully evaluated for other etiologies after ruling out acute coronary process. We report 2 male adolescents with myopericarditis who presented to the emergency department with chest pain and elevated cardiac enzymes.
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Clinical characteristics and causes of chest pain in 380 children referred to a paediatric cardiology unit. Cardiol Young 2013; 23:361-7. [PMID: 22874139 DOI: 10.1017/s1047951112000881] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Chest pain is a common presenting complaint to paediatrics, paediatric cardiology, and paediatric emergency departments. In this study, we prospectively evaluated clinical characteristics and causes of chest pain in children referred to our paediatric cardiology unit. METHODS A total of 380 children were included. Associated symptoms and past and family histories were evaluated. All patients underwent physical examination. The following studies were performed: complete blood count in all patients; fasting lipid profiles in overweight and obese children and children with a family history of premature cardiovascular disease; and electrocardiogram, chest X-ray, and echocardiogram in all patients. If necessary, 24-hour electrocardiogram monitoring or exercise stress tests were performed. Patients with a history of positive psychological findings were evaluated by a child psychiatrist. RESULTS The most common causes of chest pain were musculoskeletal disorders (37.1%), idiopathic chest pain (29.2%), and miscellaneous disorders, for example precordial catch syndrome (15%), respectively. Only 1 of 380 (0.3%) patients had chest pain due to a cardiac disorder. Electrocardiograms were abnormal in 4 of 380 (1.1%) patients. A total of 9 of 380 patients (2.3%) had dyslipidaemia. CONCLUSIONS Although a paediatric cardiology referral may provide reassurance to the primary care and emergency department physicians, our results show that cardiac aetiologies for paediatric chest pain are very rare. We think that many patients in our study were adequately evaluated only by careful history, and physical examination. Therefore, we suggest that it may not be necessary to use echocardiogram in the routine evaluation of children with chest pain.
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Loiselle KA, Lee JL, Gilleland J, Campbell R, Simpson P, Johnson G, Dooley K, Blount RL. Factors associated with healthcare utilization among children with noncardiac chest pain and innocent heart murmurs. J Pediatr Psychol 2012; 37:817-25. [PMID: 22493013 DOI: 10.1093/jpepsy/jss055] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine differences in factors related to health care utilization (HCU) among children eventually diagnosed with noncardiac chest pain (NCCP) or an innocent heart murmur (IHM). METHODS 67 pediatric patients with NCCP and 62 with IHM and their parent/guardian completed paper-and-pencil measures of psychological functioning and past HCU during an initial visit to the cardiologist's office. RESULTS Children with NCCP utilized significantly more health care services compared to their IHM counterparts in the year prior to their cardiology visit. Children in the NCCP group had higher internalizing and somatic symptoms, and their parents experienced more anxious symptoms, than those in the IHM group. For the NCCP group only, child and parent psychological symptoms and parent HCU were positively related to child HCU. CONCLUSIONS Results identify possible child and parent psychological factors that may be the focus of interventions to reduce high rates of HCU among children with NCCP.
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