Chest pain and its recurrence in pediatric population: A large cohort study

Öz

Introduction: Chest pain is a common complaint in children. In this retrospective study we investigated the clinical and etiological characteristics and the recurrence rates of chest pain in a large cohort of patients. Material and Method: This study enrolled children under the age of 18 years who admitted to our pediatrics and pediatric cardiology departments with the chief complaint of chest pain. The medical files and laboratory data of patients with chest pain were retrospectively reviewed. Results: Among 503 patients with chest pain, 346 (68.7%) cases were referred to pediatric cardiology department because of a suspicious of a cardiac chest pain. Non-cardiac related chest pain accounted for 95.2% (478 patients) and cardiac related chest pain accounted for 4.8% (25 patients). A total of 23 (92%) patients in cardiac-related chest pain group and 212 (44.3%) patients in non-cardiac related group had recurrent chest pain. Recurrent chest pain was commonly detected in cardiac related chest pain, respiratory, gastrointestinal and psychological disorders. Discussion and Conclusion: In this study, the most common etiologies of chest pain in children were idiopathic chest pain and musculoskeletal disorders. Although, our results showed that chest pain is commonly recurrent and cardiac causes of chest pain are very rare in children. Unnecessary referrals should be reduced with a careful history and physical examination.

Anahtar Kelimeler

• Chest pain
• children
• recurrence
• cardiac related
• refferals

Çocukluk çağında göğüs ağrısı ve tekrarlama sıklığı: Geniş bir toplum çalışması

Öz

Amaç: Göğüs ağrısı çocuklarda yaygın görülen bir şikâyettir. Bu retrospektif çalışmada pediatri bölümüne başvuran ve pediatrik kardiyoloji bölümüne sevk edilen geniş bir hasta grubunda göğüs ağrısının klinik ve etiyolojik özellikleri ile tekrarlama oranlarını araştırdık. Gereç ve Yöntem: Bu çalışmaya pediatri bölümümüze başvuran ve göğüs ağrısı şikayeti ile pediatrik kardiyoloji bölümüne sevk edilen 18 yaşın altındaki çocuklar dâhil edildi. Göğüs ağrısı olan hastaların tıbbi dosyaları ve laboratuar verileri retrospektif olarak incelendi. Bulgular: Göğüs ağrısı olan 503 hastadan 346'sı (% 68.7) kardiyak göğüs ağrısı şüphesi nedeniyle pediatrik kardiyoloji bölümüne sevk edilmişti. Kardiyak nedenlerle ilişkili olmayan göğüs ağrısı %95.2 (478 hasta), kardiyak nedenlerle ilişkili göğüs ağrısı %4.8 (25 hasta) oranlarında idi. Kardiyak nedenlerle ilişkili göğüs ağrısı grubunda 23 hasta (%92) ve kardiyak olmayan grupta 212 hastada (% 44.3) tekrarlayan göğüs ağrısı vardı. Tekrarlayan göğüs ağrısı, kardiyak nedenlerle ilişkili göğüs ağrısı, solunum, gastrointestinal ve psikolojik bozukluklarda yaygın olarak saptandı. Sonuç ve Tartışma: Bu çalışmada, çocuklarda göğüs ağrısının en sık etiyolojik nedeni idiyopatik göğüs ağrısı ve kas-iskelet sistemi hastalıkları olarak bulunmuştur. Ayrıca, bizim sonuçlarımız çocuklarda göğüs ağrısının sık tekrarladığını ve göğüs ağrısının kardiyak nedenlerinin çocuklarda çok nadir olduğunu göstermiştir. Sonuç olarak, dikkatli bir öykü ve fizik muayene ile gereksiz sevk ve yönlendirmeler azaltılabilir.

Anahtar Kelimeler

• Göğüs ağrısı
• çocuklar
• tekrarlama
• kalple ilişkili
• sevkler

Kaynakça

1. References Referans 1 Selbst SM, Ruddy RM, Clark BJ. Pediatric chest pain: a prospective study. Pediatrics 1988;82(3):319–23.
2. Referans 2 Ives A Daubeney PE, Balfour-Lynn IM. Recurrent chest pain in the well child. Arch Dis Child 2010;95(8):649–54. doi: 10.1136/adc.2008.155309.
3. Referans 3 Geggel RL. Conditions leading to pediatric cardiology consultation in a tertiary academic hospital. Pediatrics 2004;114(4):e409–17.
4. Referans 4 Cava JR, Sayger PL. Chest pain in children and adolescents. Pediatr Clin North Am 2004;51(6):1553–68.
5. Referans 5 Sert A, Aypar E, Odabas D, Gokcen C. Clinical characteristics and causes of chest pain in 380 children referred to a paediatric cardiology unit. Cardiol Young 2013;23(3):361-7. doi: 10.1017/S1047951112000881.
6. Referans 6 Selbst SM, Ruddy R, Clark BJ. Chest pain in children. Follow-up of patients previously reported. Clin Pediatr 1990;29(7):374–377.
7. Referans 7 Tunaoglu FS, Olguntürk R, Akcabay S, Oguz D, Gücüyener K, Demirsoy S. Chest pain in children referred to a cardiology clinic. Pediatr Cardiol 1995;16(2):69–72.
8. Referans 8 Fukushige J, Tsuchihashi K, Harada T, Ueda K. Chest Pain in Pediatric Patients. Pediatr Int 1988;30(5):604–7. doi:10.1111/j.1442-200x.1988.tb01586.x

9. Referans 9 Verghese GR, Friedman KG, Rathod RH, et al. Resource utilization reduction for evaluation of chest pain in pediatrics using a novel Standardized Clinical Assessment and Management Plan (SCAMP). J Am Heart Assoc 2012;1(2):pii: jah3-e000349. doi: 10.1161/JAHA.111.000349.
10. Referans 10 Friedman KG, Kane DA, Rathod RH, et al. Management of pediatric chest pain using a standardized assessment and management plan. Pediatrics 2011;128(2):239-45. doi: 10.1542/peds.2011-0141.
11. Referans 11 Kane DA, Friedman KG, Fulton DR, Geggel RL, Saleeb SF. Needles in hay II: detecting cardiac pathology by the pediatric chest pain standardized clinical assessment and management plan. Congenit Heart Dis 2016;11(5):396-402. doi: 10.1111/chd.12335.
12. Referans 12 Daniels SR, Greer FR. Committee on nutrition. Lipid screening and cardiovascular health in childhood. Pediatrics 2008;122(1):198–208. doi: 10.1542/peds.2008-1349.
13. Referans 13 Lopez L, Colan SD, Frommelt PC, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr 2010;23(5):465–95. doi: 10.1016/j.echo.2010.03.019.
14. Referans 14 Selbst SM. Chest pain in children. Pediatrics 1985;75(6):1068–70.
15. Referans 15 Zavaras-Angelidou, KA Weinhouse E, Nelson DB. Review of 180 episodes of chest pain in 134 children. Pediatr Emerg Care 1992;8(4):189–93.
16. Referans 16 Massin MM, Bourguignont A, Coremans C, Comté L, Lepage P, Gérard P. Chest pain in pediatric patients presenting to an emergency department or to a cardiac clinic. Clin Pediatr (Phila) 2004;43(3):231–8.
17. Referans 17 Driscoll DJ, Glicklich LB, Gallen WJ. Chest pain in children: a prospective study. Pediatrics 1976;57(5):648–51.
18. Referans 18 Peitz GW, Troyer J, Jones AE, et al. Association of body mass index with increased cost of care and length of stay for emergency department patients with chest pain and dyspnea. Circ Cardiovasc Qual Outcomes 2014;7(2):292-8. doi: 10.1161/CIRCOUTCOMES.113.000702.
19. Referans 19 Cozzi G, Minute M, Skabar A, et al. Somatic symptom disorder was common in children and adolescents attending an emergency department complaining of pain. Acta Paediatr 2017;106(4):586–93. doi: 10.1111/apa.13741.