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Pediatric chest pain: a prospective study
S M Selbst1, R M Ruddy, B J Clark
1Division of General Pediatrics, Children's Hospital of Philadelphia, PA 19104.
Insights
Childhood chest pain is usually benign, with most cases stemming from non-cardiac causes like idiopathic or musculoskeletal issues. Cardiac problems are rare, affecting only 4% of children presenting with chest pain.
Area of Science:
- Pediatrics
- Cardiology
- Emergency Medicine
Background:
- Previous childhood chest pain studies were limited by retrospective designs or restricted patient groups.
- Prospective evaluation of all emergency department admissions for chest pain in children was lacking.
Purpose of the Study:
- To prospectively evaluate the causes and characteristics of chest pain in a pediatric emergency department population.
- To identify factors associated with organic versus nonorganic causes of chest pain in children.
Main Methods:
- Prospective evaluation of 407 children admitted with chest pain.
- Electrocardiograms (ECGs) and echocardiograms performed for ill-defined chest pain.
- Analysis of pain characteristics, physical findings, and diagnostic test results.
Main Results:
- Idiopathic (21%) and musculoskeletal (15%) causes were most common; cardiac problems occurred in 4%.
- Chest wall tenderness was the most frequent abnormality. ECG and echocardiogram abnormalities were often unrelated to the final diagnosis.
- Younger children were more prone to cardiorespiratory issues, while older children (>12 years) showed more psychogenic pain.
Conclusions:
- Childhood chest pain is predominantly benign, with non-cardiac origins being far more prevalent than previously thought.
- Organic disease is linked to acute onset, fever, and abnormal exams, while nonorganic disease correlates with family history and chronic pain.
- Laboratory tests are rarely beneficial; diagnosis relies on clinical evaluation and targeted investigations.
Abstract:
Previous studies of childhood chest pain have been retrospective or considered only limited age groups or referred patients. In this study, all children who were admitted to the emergency department with chest pain were evaluated prospectively. Patients with ill-defined chest pain had ECGs and echocardiograms performed. A total of 407 children were evaluated. The most common causes of the pain were idiopathic (21%) and musculoskeletal (15%). Cardiac problems were found in 4%. Chest pain was acute (of less than 48 hours' duration) in 43% and chronic (of greater than 6 months' duration) in 7%. Pain caused 30% of children to stay out of school and 31% to awaken from sleep. Chest wall tenderness was the most common abnormality. ECGs were obtained in 47%; results of 31/191 were abnormal but only 4/191 ECG abnormalities were related to the diagnosis. Echocardiograms were obtained in 34%; results of 17/139 were abnormal (12/139 showed mitral valve prolapse). Young children are more likely to have cardiorespiratory problems; children older than 12 years of age are more likely to have psychogenic pain. The description and location of the pain and the patient's sex are not related to the diagnosis. Nonorganic disease is related to a family history of heart disease or chest pain or having chronic pain. Organic disease is related to pain of acute onset, abnormal physical examination results, pain that awakens the child from sleep, and the presence of fever. Laboratory tests are rarely helpful in evaluating children with chest pain. Chest pain in children is usually benign. Psychogenic pain and idiopathic pain are less common than previously believed.