Factors associated with healthcare utilization among children with noncardiac chest pain and innocent heart murmurs

Bodily sensations and quality of life in adolescents with non-cardiac chest pain: a comparative study for the undetermined part of a frequent health problem

BACKGROUND

Chest pain in adolescents represents a considerable burden for health services and is rarely associated with cardiac disease. Since chest pain could be related to psychosocial factors there is a need for exploring the relationships among stressful situations, drug consumption, suicidal behaviors, accompanying bodily symptoms and health-related quality of life in adolescents with non-cardiac chest pain.

METHODS

In this study, we assessed these determinants in 108 adolescents with non-cardiac chest pain (NCCP) and a control group of 77 patients using a structured interview applied to the patients presented to the cardiology outpatient clinics of Tepecik Training and Research Hospital, İzmir, Türkiye, between 30 October 2018 and 30 June 2019. After the interview, the adolescents were given a self-administered pediatric quality of life inventory and the body sensations questionnaire for assessing aspects of fear.

RESULTS

Adolescents with NCCP expressed more panic associated bodily symptoms and reported worse subjective physical, academic, and emotional functioning in addition to more suicidal ideation.

CONCLUSIONS

NCCP could be accepted as a warning sign of an underlying psychosocial problem and requires a more interdisciplinary collaborative care by pediatricians, psychologists, and psychiatrists.

Emergency Department Admissions of Children with Chest Pain before and during COVID-19 Pandemic

OBJECTIVES

We compared the number of accesses, causes, and instrumental evaluations of chest pain in children between the pre-COVID-19 era and the COVID-19 period and analyzed the assessment performed in children with chest pain, highlighting unnecessary examinations.

METHODS

We enrolled children with chest pain admitted to our emergency department between January 2019 and May 2021. We collected demographic and clinical characteristics and findings on physical examinations, laboratory tests, and diagnostic evaluations. Then, we compared the number of accesses, causes, and instrumental assessments of chest pain between the pre-COVID-19 era and the COVID-19 era.

RESULTS

A total of 111 patients enrolled (mean age: 119.8 ± 40.48 months; 62 males). The most frequent cause of chest pain was idiopathic (58.55%); we showed a cardiac origin in 4.5% of the cases. Troponin determination was performed in 107 patients, and the value was high only in one case; chest X-rays in 55 cases and echocardiograms in 25 cases showed pathological findings, respectively, in 10 and 5 cases. Chest pain accesses increased during the COVID-19 era (p < 0.0001), with no differences in the causes of chest pain between the two periods.

CONCLUSIONS

The increase in accesses for chest pain during the COVID-19 pandemic confirms that this symptom generates anxiety among parents. Furthermore, our findings demonstrate that the evaluation of chest pain is still extensive, and new chest pain assessment protocols in the pediatric age group are needed.

Adolescents with unexplained chest pain reported depression and impaired emotional and social functioning

AIM

Chest pain is common in adolescence, but there are no established criteria for managing this problem, which is rarely associated with cardiac disease. This study addressed the gaps in the literature by evaluating psychosocial factors that could be associated with medically unexplained chest pain.

METHODS

We consecutively selected 100 patients (68% girls) aged 13-18 who were diagnosed with unexplained chest pain when they presented to the cardiology outpatient clinics of Tepecik Research Hospital, İzmir, Turkey, between 30 September 2015 and 30 June 2018. The controls were 76 age- and sex-matched adolescents (69% girls) aged 13-18 who were undergoing routine cardiology assessments before joining sports clubs. We assessed their health-related quality of life and any depression and physical symptoms.

RESULTS

Regression analysis showed some adolescents were a number of times more likely to report chest pain. These included those who reported boredom (4.1 times), felt stressed or anxious (2.2) and those who experienced sleep disturbance (2.6), co-morbid headaches (2.0), back pain (3.1) and impaired social functioning (1.2).

CONCLUSION

The results indicated a significant association between unexplained chest pain and physical symptoms, depression and impaired emotional and social functioning. These factors warrant further evaluation.

Meta-Analysis: Association of Parent and Child Mental Health with Pediatric Health Care Utilization

OBJECTIVE

To examine the association of psychological factors and pediatric health care utilization.

METHOD

Ovid Medline and PsychInfo were searched and archival and forward searchers were conducted of relevant articles. Studies of the association between psychological risk factors and pediatric health care utilization of outpatient services, emergency department, inpatient length of stay, and costs were identified. Effect sizes were expressed in the form of the standardized mean difference. From 4,546 studies identified in the search, 69 studies met inclusion criteria.

RESULTS

There were significant low-moderate associations between higher outpatient visits and general child mental health (MH) problems (mean ES [mES] = 0.35), overall psychopathology (mES = 0.44), and internalizing symptoms (mES = 0.16). Results were significant for any parent MH problem (mES = 0.18). For emergency department (ED) visits, there were significant association between more ED visits and any child MH problems (mES = 0.25), internalizing symptoms (mES = 0.24), externalizing symptoms (mES = 0.16), and Attention Deficit/Hyperactivity Disorder (mES= 0.14), as well as parent MH (mES = 0.24) and maternal depression (mES = 0.21). Increased hospitalizations were associated with any child MH problem (mES = 0.3), overall child psychopathology (mES = 0.49), child depression (ES = 0.41), and any parent MH problem (mES = 0.54). For costs, results were significant for any child MH problem (mES = 0.38).

CONCLUSIONS

Child and parent MH problems are significantly associated with increased HCU.

Innocent Heart Murmur

Heart murmur is the most common reason for a referral to a pediatric cardiologist. Virtually all children have a heart murmur during their childhood. Less than 1% of murmurs are pathological in children. Innocent/functional heart murmur is the most common type of heart murmur. There are multiple theories proposed to identify etiology of innocent heart murmur with varying consensus, but everybody agrees that innocent heart murmur does not carry any morbidity or mortality risk. Even today, heart murmur is associated with high physician uncertainty and parental anxiety. Extensive cardiac evaluation for such a benign finding is also associated with high health care utilization and cost. This article attempts to review this long-known finding which continues to remain a diagnostic challenge.

Associations between parental mental health and other family factors and healthcare utilisation among children and young people: a retrospective, cross-sectional study of linked healthcare data

OBJECTIVE

To identify the degree to which parental diagnosis of depression or other long-term conditions, parental health-seeking behaviours and household factors were associated with a healthcare utilisation among children and young people (CYP) (0-15 years).

DESIGN

Retrospective, cross-sectional study of electronic health records, from 25 252 patients registered at a large, London-based primary care provider. The associations between children's healthcare utilisation and the characteristics of the child, their parents/carers and their household structure were examined using multivariable regression.

RESULTS

Controlling for parental utilisation, parental depression (vs not) was significantly associated with increased healthcare utilisation for CYP. Odds ratios for CYP with siblings=1.41 (95% CI 1.10 to 1.80) for emergency department (ED) attendances, 1.67 (95% CI 1.32 to 2.11) for outpatient appointments, 1.47 (95% CI 1.07 to 2.03) for inpatient admission, and rate rato=1.28 (95% CI 1.04 to 1.78) for general practitioner (GP) consultations.After adjusting for child and parental characteristics, parental general practice attendance (+1 from mean) was predictive of increased CYP general practice attendance, rate ratio 1.07 (95% CI 1.06 to 1.08) for CYP with siblings. Parental ED attendance also increased the risk of CYP ED attendance, with OR 1.27 (95% CI 1.12 to 1.44) for CYP with siblings.

CONCLUSIONS

Parental depression is associated with increased utilisation of ED, outpatient and inpatient services by CYP, as well as with increased GP consultations among adolescents. Our results demonstrate that healthcare utilisation by CYP is associated with the health-seeking behaviour of adults in their household.

A teen with chest pain

Chest pain is a frequent symptom and complaint in the teenage population. There are many common, benign causes of chest pain. However, it can create tremendous anxiety in the mind of the patient and family members and sometimes it can be perplexing even for the primary providers especially if there is associated family history of premature coronary artery disease. This article focuses on the evaluation of chest pain and how to differentiate between noncardiac and cardiac causes of chest pain in teenagers.

Functional somatic symptoms in childhood and adolescence

PURPOSE OF REVIEW

Functional somatic symptoms (FSS) are common in children and adolescents, but explanatory models that synthesize research findings are lacking. This article reviews the studies published from January 2012 to March 2013 that investigate the neurophysiological mechanisms that may underlie FSS.

RECENT FINDINGS

Studies from diverse medical disciplines suggest that FSS are associated with functional differences in hypothalamic-pituitary-adrenal function, imbalances in vagal-sympathetic tone, upregulation of immune-inflammatory function, and primed cognitive-emotional responses that serve to amplify reactivity to threatening stimuli, thereby contributing to the subjective experience of somatic symptoms.

SUMMARY

FSS appear to reflect dysregulations of the stress system. When seemingly disparate research findings are interpreted together within an overarching 'stress-system' framework, a coherent explanatory model begins to emerge.

Parental information, motivation, and adherence behaviors among children with sickle cell disease

BACKGROUND

Identification of psychosocial correlates of health care utilization has become an important strategy in improving clinical care. The objective of the study was to examine the fit of the Information-Motivation-Behavioral Skills (IMB) model, applied to health care utilization among children with sickle cell disease (SCD).

PROCEDURE

Participants were parents of 150 children, ages 1-17 years, receiving care in a sickle cell center. Parents completed questionnaires assessing information, motivation, adherence behaviors, and other factors with respect to SCD management. Data regarding health care utilization in the previous 12 months were obtained from parent report and electronic medical records. Stepwise multiple regression analysis was conducted to determine associations between IMB factors and health care use.

RESULTS

Parents rated highly in the domains of information, motivation, and adherence behaviors for managing their child's SCD. Children of parents reporting higher satisfaction with social supports had higher odds (OR 1.49, 95% CI 1.03-2.15) of two or more routine hematology visits in the previous 12 months. Neither information nor adherence behavior was associated with urgent or routine care use. Among other variables measured, high parental illness-related stress and child health status reported as fair/poor were the strongest predictors of urgent care use while private insurance type was the strongest predictor of routine care use.

CONCLUSIONS

Among IMB factors, social support was associated with routine health care utilization. Social support and parental illness-related stress may serve as important, modifiable targets in interventions to allocate needed resources to families and reduce unnecessary medical care.