Regional implementation of a pediatric cardiology chest pain guideline using SCAMPs methodology

Area of Science:

• Pediatric Cardiology
• Clinical Guideline Development
• Healthcare Management

Background:

• Chest pain is a common pediatric complaint, often leading to extensive evaluations.
• Cardiac etiologies for pediatric chest pain are infrequent, despite significant resource utilization.
• The Standardized Clinical Assessment and Management Plans (SCAMPs) methodology offers a novel approach to clinical evaluation.

Purpose of the Study:

• To validate a clinical guideline for cost-effective evaluation of pediatric chest pain.
• To assess the efficacy of the SCAMPs methodology in a regional setting.
• To determine the prevalence of cardiac causes for chest pain in ambulatory pediatric patients.

Main Methods:

• A total of 1016 ambulatory patients (ages 7-21) with chest pain were evaluated using the SCAMPs chest pain guideline.
• Data analysis focused on diagnostic elements, care patterns, and guideline compliance.
• Comparison of care patterns between a core academic center (Boston Children's Hospital) and regional practices (New England Congenital Cardiology Association).

Main Results:

• Only two patients (0.2%) had a cardiac etiology for their chest pain (pericarditis and anomalous coronary artery).
• Testing outside guideline recommendations yielded only incidental findings.
• Persistent symptoms in returning patients were not attributed to cardiac disease.
• Care patterns showed minimal differences between the academic center and regional practices.

Conclusions:

• The SCAMPs methodology enables efficient and effective ambulatory evaluation of pediatric chest pain with minimal resources.
• Chest pain in children is rarely indicative of serious cardiac conditions.
• The SCAMPs approach is adaptable to various clinical settings and can overcome barriers to guideline implementation.