P163 Assessment of children with chest pain visiting the emergency department

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Abstract

Background and aims

Children frequently present to an emergency department (ED) with the complaint of chest pain. Between 0.3% and 0.6% of visits to a paediatric emergency department are for chest pain. Unlike adult patients with chest pain, most studies have shown that children with chest pain rarely have serious organic pathology. Infrequently, a child with chest pain will present with significant distress and require immediately resuscitation. Most children with chest pain are not in extremis and for many the pain is not acute in nature. We assess and analyse the aetiology of chest pain among children visiting a paediatric ED in one medical centre.

Methods

We retrospectively reviewed the medical records of children with chest pain who visited our ED between January 2015 and December 2016 and were admitted to hospital. Any case of trauma- associated chest pain was excluded from this study. Demographic data including age, sex, clinical presentation, chest radiographs, laboratory tests, electrocardiogram (ECG), echocardiography, and final diagnosis were sorted for assessment. ECGs were reviewed by a adult cardiologist at hospital and echocardiograms were reviewed by a private paediatric cardiologist after hospitalisation. Diagnoses were grouped into idiopathic chest pain, respiratory origin, cardiac problem, gastrointestinal disorder, musculoskeletal pain, anxiety and miscellaneous.

Results

A total of 22 patients (10 boys, 12 girls; mean age, 12 years; age range, 7–14 years) were enrolled into this study. The duration of chest pain before visiting our ED had lasted between minutes to half day (mean, 1 hours). Fifteen (68.1%) children suffered from chest pain for less than 30 min. Associated symptoms occurred in less than half of these patients, including fever or respiratory symptoms (cough, dyspnea) in two, gastrointestinal symptoms (epigastric pain, nausea, vomiting) in three, dizziness in two and palpitation in five. Physical examination disclosed abnormalities in 10% of the patients. Heart murmur was first noted in seven patients. All patients had electrocardiogram study (100%) and 1 of them showed abnormalities. Additional diagnostic tests were performed in all patients (100%), including complete blood analysis, creatine kinase (CK) MB isoenzyme, and C-reactive protein. Echocardiograms by paediatric cardiologist were performed in 19 (86.3%) patients after hospitalisation in a private basis. Overall, idiopathic chest pain was the most common diagnosis (54.5%). Other associated disorders were musculoskeletal (22.8%), gastrointestinal (9.1%), and anxiety (13.6%).

Conclusion

The most common cause of chest pain prompting a child to visit the ED is idiopathic chest pain. To ascribe a chest pain as idiopathic, we need to exclude both organic etiologies and psychological factors contributing to the chest pain. The most important evaluations are through history-taking and detailed physical examination, although we suggest evaluation by paediatric cardiologist for every child with chest pain before ascribe this as idiopathic. Laboratory tests are not efficient tools for screening.

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