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Pediatric Chest Pain: A Review of Diagnostic Tools in the Pediatric Emergency Department
1Emergency Department, Wan Fang Hospital, Taipei Medical University, Taipei 11695, Taiwan.
Insights
Pediatric chest pain is usually benign, with musculoskeletal causes being most common. A standardized algorithm can reduce unnecessary diagnostic tests for children experiencing chest pain.
Area of Science:
- Pediatric Emergency Medicine
- Cardiology
- Diagnostic Imaging
Background:
- Pediatric chest pain is a frequent emergency department (ED) complaint, often causing parental anxiety due to concerns about cardiac conditions.
- Despite parental fears, chest pain in children is typically associated with benign conditions.
Purpose of the Study:
- To review the common etiologies of pediatric chest pain.
- To evaluate the diagnostic utility of common tests for cardiac causes.
- To propose a standardized approach to reduce unnecessary investigations.
Main Methods:
- Literature review of studies on pediatric chest pain.
- Analysis of reported etiologies and their prevalence.
- Assessment of the sensitivity of diagnostic procedures like ECG and chest radiography for cardiac causes.
Main Results:
- Musculoskeletal pain is the most frequent cause (38.7-86.3%), followed by pulmonary, gastrointestinal, and psychogenic factors.
- Cardiac causes account for a small percentage (0.3-8.0%) of pediatric chest pain.
- Diagnostic tests such as ECG (0-17.8% sensitivity) and chest radiography (11.0-17.2% sensitivity) have limited ability to detect cardiac etiologies.
Conclusions:
- A structured diagnostic algorithm is needed to manage pediatric chest pain effectively.
- Implementing a standardized algorithm can minimize unnecessary testing while ensuring critical diagnoses are not missed.
Abstract:
Pediatric chest pain is a common chief complaint in the emergency department. Not surprisingly, children with chest pain are usually brought to the emergency department by their parents out of fear of heart disease. However, chest pain in the pediatric population is generally a benign disease. In this review, we have identified musculoskeletal pain as the most prevalent etiology of chest pain in the pediatric population, accounting for 38.7-86.3% of cases, followed by pulmonary (1.8-12.8%), gastrointestinal (0.3-9.3%), psychogenic (5.1-83.6%), and cardiac chest pain (0.3-8.0%). Various diagnostic procedures are commonly used in the emergency department for cardiac chest pain, including electrocardiogram (ECG), chest radiography, cardiac troponin examination, and echocardiography. However, these examinations demonstrate limited sensitivity in identifying cardiac etiologies, with sensitivities ranging from 0 to 17.8% for ECG and 11.0 to 17.2% for chest radiography. To avoid the overuse of these diagnostic tools, a well-designed standardized algorithm for pediatric chest pain could decrease unnecessary examination without missing severe diseases.
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