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Chest pain in children. Follow-up of patients previously reported
S M Selbst1, R Ruddy, B J Clark
1Emergency Department, Children's Hospital of Philadelphia, PA 19104.
Insights
Follow-up care for children experiencing chest pain is crucial due to persistent symptoms. However, serious underlying conditions, like heart abnormalities, are rarely discovered during long-term monitoring.
Area of Science:
- Pediatrics
- Cardiology
- Emergency Medicine
Background:
- Chest pain is a common presenting complaint in pediatric emergency departments.
- Previous analysis reported initial diagnoses for children with chest pain.
- Long-term outcomes and diagnostic shifts require further investigation.
Purpose of the Study:
- To assess the diagnostic evolution and long-term outcomes of pediatric chest pain patients.
- To determine the frequency of new organic etiologies discovered during follow-up.
- To evaluate the necessity of continued monitoring for pediatric chest pain.
Main Methods:
- Prospective follow-up of 149 children initially diagnosed with chest pain.
- Analysis of diagnostic changes over a minimum 6-month to 2-year period.
- Review of patient visits and reassessment of initial diagnoses.
Main Results:
- Initial diagnoses were altered in 34% of cases during follow-up.
- Nonorganic causes were frequently identified as the primary reason for chest pain.
- New organic etiologies were rare, with only 12 of 149 children diagnosed with a new condition (e.g., asthma, mitral valve prolapse).
- Chest pain symptoms persisted in 43% of followed children.
Conclusions:
- Pediatric chest pain often resolves or is attributed to nonorganic causes.
- While symptoms may persist, serious underlying diseases are uncommon in this population.
- Continued follow-up is recommended for children with chest pain due to symptom persistence, despite the low likelihood of discovering severe pathology.
Abstract:
During a 1-year period, 407 children with chest pain were seen in the Emergency Department of Children's Hospital of Philadelphia. Analysis of the clinical data of these children was reported previously. The authors successfully followed 149 of these children for 6 months or more, and 51 for 2 years or more. These patients returned for an average of 3.4 visits during the follow-up period. Thirty-four percent of the initial diagnoses were altered. Usually, during the follow-up period, the authors concluded that chest pain resulted from nonorganic causes. A new organic etiology was uncovered in only 12 of 149 cases. Only 1 child was found to have a heart abnormality (mitral valve prolapse), and 3 were found to have asthma. Chest pain did not resolve during the follow-up period in 43 percent of those followed. Children with chest pain should have follow-up care because of the persistence of symptoms, but serious disease is unlikely to be found over time.