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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.

Pediatrics
|September 1, 1988
PubMed
Summary
This summary is machine-generated.

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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.

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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.