Chest Pain in the Pediatric Emergency Department: Evaluation of Clinical and Laboratory Findings of Patients

Yıl 2023, Cilt: 13 Sayı: 1, 45 - 50, 26.04.2023

Hale Çitlenbik Aslı Şener

Öz

Aim: Chest pain is a very common complaint in children and adolescents, and it is one of the common reasons for applying to the pediatric emergency department. Determining the etiological causes of chest pain in childhood is necessary to apply the right treatment and relieve the family and child’s concerns. This study was planned to retrospectively examine the clinical and laboratory findings of children admitted to the pediatric emergency department with chest pain, evaluate the etiological causes, and investigate the pathological findings detected in cases with a cardiac cause.
Material and Method: The study included pediatric patients aged <18 who presented to the pediatric emergency department with chest pain between January 2019 and January 2022. Patient files were reviewed retrospectively, and age, gender, time of admission and season, symptoms at presentation, physical examination findings, chest X-ray findings, electrocardiography and echocardiography findings, laboratory findings, final diagnosis, hospitalization, and duration were recorded.
Results: Two hundred and forty-eight patients were included in the study, 119 (48%) of whom were male, while 129 (52%) were female. The median age was 14 years (IQR: 10–16). Mostly musculoskeletal, respiratory, and idiopathic causes were identified in the etiology of chest pain. In the cases with a cardiac cause, it was observed that chest pain was accompanied by symptoms such as palpitation and syncope, and pathological physical examination and ECG findings were more common.
Conclusion: Chest pain is one of the most common reasons for referral to the pediatric emergency department. In contrast to adults, chest pain of cardiac origin is extremely rare in childhood, and the cause of chest pain is usually benign. While evaluating patients who present to the pediatric emergency department with chest pain, a detailed anamnesis, and comprehensive physical examination should provide guidance, and detailed tests should be performed in necessary cases.

Anahtar Kelimeler

children, chest pain, pediatric emergency department

Kaynakça

• 1. Selbst SM, Ruddy RM, Clark BJ, Henreting FM, Santulli Jr T. Pediatric chest pain: a prospective study. Pediatrics. 1988; 82:319–23.
• 2. Friedman KG, Alexander ME. Chest pain and syncope in children: a practical approach to the diagnosis of cardiac disease. J Pediatr. 2013; 163:896–901.
• 3. Danduran MJ, Earing MG, Sheridan DC, Ewalt LA, Frommelt PC. Chest pain: characteristics of children/adolescents. Pediatr Cardiol. 2008; 29:775–81.
• 4. Rowe BH, Dulberg CS, Peterson RG, Vlad P, Li MM. Characteristics of children presenting with chest pain to a pediatric emergency department. CMAJ. 1990; 143:388–94.
• 5. Saleeb SF, McLaughlin SR, Graham DA, Friedman KG, Fulton DR. Resource reduction in pediatric chest pain: standardized clinical assessment and management plan. Congenit Heart Dis. 2018; 13:46–51.
• 6. Chun JH, Kim TH, Han MY, Kim NY, Yoon KL. Analysis of clinical characteristics and causes of chest pain in children and adolescents. Korean J Pediatr. 2015; 58:440–5.
• 7. Sert A, Aypar E, Odabas D, Gokcen C. Clinical characteristics and causes of chest pain in 380 children referred to a pediatric cardiology unit. Cardiol Young. 2013; 23:361–7.
• 8. Gesuete V, Fregolent D, Contorno S, Tamaro G, Barbi E, Cozzi G. Followup study of patients admitted to the pediatric emergency department for chest pain. Eur J Pediatr. 2019; 179:303–8.
• 9. Saleeb SF, Li WY, Warren SZ, Lock JE. Effectiveness of screening for life-threatening chest pain in children. Pediatrics. 2011; 128:1062–8.
• 10. Hanson CL, Hokanson JS. Etiology of chest pain in children and adolescents referred to cardiology clinic. WMJ. 2011; 110:58–62.
• 11. Geggel RL. Conditions leading to pediatric cardiology consultation in a tertiary academic hospital. Pediatrics. 2004; 114:409–17.
• 12. Aygun E, Aygun ST, Uysal T, Aygun F, Dursun H, Irdem A. Aetiological evaluation of chest pain in childhood and adolescence. Cardiol Young. 2020; 30:617–23.
• 13. Doğan M, Kalın T, Özer U, Öztürk MA. Çocuk acil servisine göğüs ağrısı nedeniyle başvuran hastaların değerlendirilmesi. MKÜ Tıp Dergisi. 2020; 11:9–13.
• 14. Friedman KG, Kane DA, Rathod RH, Renaud A, Farias M, Geggel R, et al. Management of pediatric chest pain using a standardized assessment and management plan. Pediatrics. 2011; 128:239–45. 15. Akalın F. Adölesanda göğüs ağrısına yaklaşım. Türk Pediatri Arşivi. 2010; 3:164–6.
• 16. Driscoll DJ. Chest pain in children and adolescents. In: Allen HD, Driscoll DJ, Shaddy RE, Feltes TF (eds). Moss and Adams’ Heart Disease in infants, children, and Adolescents: Including the Fetus and Young Adult. 7th ed. Philadelphia, Lippincott Williams & Wilkins,. 2008; pp. 1444–6.
• 17. Mohan S, Nandi D, Stephens P, M’Farrej M, Vogel RL, Bonafide CP. Implementation of a clinical pathway for chest pain in a pediatric emergency department. Pediatr Emerg Care. 2018; 34:778–82.
• 18. Drossner DM, Hirsh DA, Sturm JJ, Mahle WT, Goo DJ, Massey R, et al. Cardiac disease in pediatric patients presenting to a pediatric ED with chest pain. Am J Emerg Med. 2011; 29:632–8.
• 19. 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; 11:396–402.
• 20. Cohn HE, Arnold LW. Chest pain in young patients in an office setting: cardiac diagnoses, outcomes, and test burden. Clin Pediatr (Phila). 2012; 51:877–83.
• 21. Pantell RH, Goodman BW Jr. Adolescent chest pain: a prospective study. Pediatrics. 1983; 71:881–7.
• 22. Khairandish Z, Jamali L, Haghbin S. Role of anxiety and depression in adolescents with chest pain referred to a cardiology clinic. Cardiol Young. 2017; 27:125–30.
• 23. Lin CH, Lin WC, Ho YJ, Chang JS. Children with chest pain visiting the emergency department. Pediatr Neonatol. 2008; 49:26–9.
• 24. Geggel R, Endom E. Nontraumatic chest pain in children and adolescents: approach and initial management. Available at: https://www.uptodate.com/contents/nontraumaticchest-pain-in-children-and-adolescents-approach-and-initialmanagement.
• 25. Veeram SR, Reddy MD, Harinder R, Singh MD, Reddy V. Chest pain in children and adolescents. Pediatr Rev. 2010; 31:1–9. 26. Rowland TW, Richards MM. The natural history of idiopathic chest pain in children. A follow-up study. Clin Pediatr (Phila). 1986; 25:612–4.
• 27. Cava JR, Sayger PL. Chest pain in children and adolescents. Pediatr Clin N Am. 2004; 51:1553–68.
• 28. Evangelista JK, Parsons M, Renneburg AK. Chest pain in children: diagnosis through history and physical examination. J Pediatr Health Care 2000; 14:3–8.