Paediatric chest pain: evaluating diagnostic testing and clinical outcomes

Area of Science:

• Pediatric Cardiology
• Clinical Diagnostics

Background:

• Chest pain is a frequent reason for pediatric cardiology referrals.
• Most pediatric chest pain cases are benign, but diagnostic uncertainty often leads to extensive testing.

Purpose of the Study:

• To evaluate the causes of chest pain in children referred to a tertiary pediatric cardiology clinic.
• To determine the diagnostic yield of additional tests for pediatric chest pain.
• To identify children who benefit from further investigations using a risk-based strategy.

Main Methods:

• Retrospective observational study of 368 children (5-18 years) with chest pain.
• Standard evaluation included history, physical exam, and electrocardiogram (ECG).
• Additional tests (echocardiography, radiography, labs) were guided by clinical presentation and red-flag features (e.g., exertional pain, syncope, abnormal ECG).

Main Results:

• Cardiac causes were found in only 2.2% of patients; 97.8% had non-cardiac etiologies (musculoskeletal, respiratory, etc.).
• Red-flag features were associated with a significantly higher rate of cardiac diagnoses (13.5% vs. 0.3%).
• Additional tests showed low yield in patients without red-flag features.

Conclusions:

• The majority of pediatric chest pain cases are benign.
• A structured, risk-based approach utilizing red-flag features is effective in identifying children who require further cardiac evaluation.
• This approach can minimize unnecessary investigations and optimize healthcare resource utilization.