ACR Appropriateness Criteria® Chest Pain-Child

Chest pain is a common complaint in children and adolescents. The causes of chest pain are varied and include musculoskeletal, pulmonary or pleural, gastrointestinal, psychogenic, and cardiac etiologies. The etiology of pediatric chest pain is often benign but typically generates evaluation in the emergency room, urgent care, or outpatient setting. Diagnostic imaging is often used in the evaluation of pediatric chest pain. This document will discuss various clinical scenarios for children presenting with chest pain and will highlight initial imaging that is usually or may be appropriate, based on the best available evidence or expert consensus. Chest pain limited to the chest wall, from suspected pneumothorax or pneumomediastinum, secondary to suspected pulmonary embolism, from known or suspected cardiac disease, in the setting of sickle cell disease, and from suspected psychogenic causes, will be reviewed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.