Children presenting with acute pericarditis to the emergency department
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Savithiri Ratnapalan1, Kristen Brown, Lee Benson
1Division of Emergency Medicine, The Hospital for Sick Children, University of Toronto, Ontario, Canada. savithiri.ratnapalan@sickkids.ca
Insights
Pediatric pericarditis often presents with chest pain and ECG changes. Most children improve with anti-inflammatory drugs, but recurrence is common, necessitating careful follow-up.
Area of Science:
- Pediatric Cardiology
- Pediatric Emergency Medicine
- Cardiovascular Diseases
Background:
- Pericarditis in children is a significant condition requiring evaluation of clinical features and outcomes.
- Understanding the presentation and management of pediatric pericarditis is crucial for timely diagnosis and treatment.
Purpose of the Study:
- To evaluate the clinical features and outcomes of children diagnosed with acute pericarditis.
- To identify common etiologies and treatment responses in pediatric pericarditis cases.
Main Methods:
- A retrospective chart review was conducted for children diagnosed with acute pericarditis between January 2000 and March 2007.
- Data analysis focused on clinical presentation, diagnostic findings, etiology, treatment, and recurrence rates.
Main Results:
- The study included 22 children (mean age 12.3 years, 80% males) diagnosed with pericarditis.
- Chest pain (96%) and fever (56%) were common; all had ECG abnormalities. Echocardiography revealed pericardial effusion in 82%, with 32% requiring pericardiocentesis.
- Idiopathic etiology was most common (68%). All patients improved with nonsteroidal anti-inflammatory drugs, but 36% experienced recurrent pericarditis.
Conclusions:
- Children with chest pain and abnormal electrocardiograms require further investigation for pericarditis.
- Prompt diagnosis and treatment are essential, with a notable risk of recurrence in pediatric pericarditis patients.
Objective:
The objective of the study was to evaluate the clinical features and the outcome of children who presented to the emergency department and were ultimately diagnosed with pericarditis.
Methods:
A retrospective chart review of all children diagnosed with acute pericarditis from January 2000 through March 2007 was conducted.
Results:
There were 94 children with pericarditis as the sole or one of the discharge diagnoses: 34 with postsurgical pericarditis and 38 with pericarditis as a component of a generalized illness were not examined further. Of the 22 children included in the study, the mean age was 12.3 (SD, 2.7) years, and 80% were males. Chest pain was present in 96%, and fever was present in 56%. All children had electrocardiographic changes comprising ST and T-wave abnormalities. Initial chest radiographs were reported as normal in 40%; although 82% (n = 18) had a pericardial effusion on echocardiography, 7 (32%) required pericardiocentesis. The etiology was considered idiopathic in 68% (n = 15). All children improved on treatment with nonsteroidal anti-inflammatory drugs. Eight children (36%) had recurrent pericarditis, of whom 2 had multiple recurrences.
Conclusions:
Children presenting with chest pain require further investigation if electrocardiographs show any abnormalities. Children presenting with pericarditis require follow-up and caution about recurrence.
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