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Follow-up study of patients admitted to the pediatric emergency department for chest pain

  • Valentina Gesuete
  • Davide Fregolent
  • Sarah Contorno
  • Gianluca Tamaro
  • Egidio Barbi
  • Giorgio Cozzi
Original Article

Abstract

Chest pain is a relatively common cause of admission to the Emergency Department, being related in most of the cases to benign conditions with only a minority of the cases affected by heart disease. Limited data are available about the follow up of these patients in terms of risk of recurrence of symptoms, Emergency Department re-admissions, level of impairment, and school absenteeism. We identified 761 children who visited our ED with the chief complaint of chest pain, equal to 0.68% of all admissions. Twenty-four patients were excluded for a previous history of cardiac disease. Eight (1%) patients were determined to have chest pain of cardiac origin. Ninety-seven percent of patients were successfully contacted by telephone: 69% agreed to answer the questionnaire. Of these, 33% experienced recurrent chest pain, up to 41% was forced to be absent from school, about 20% was limited in its daily activities, and about 20% repeated a cardiologic evaluation.

Conclusion: Chest pain is mainly due to benign causes and is a recurrent symptom in a high percentage of patients, associated with re-admission and school absenteeism.

What is Known:

Chest pain is a relatively common cause of admission to the Emergency Department.

It is mainly due to benign causes and is among the most common reasons for referral to the pediatric cardiologist.

What is New:

Chest pain is a recurrent symptom associated with re-admission and school absenteeism.

As a family history of cardiac disease or exertional symptoms are a well-known red flag for chest pain of cardiac origin, school absenteeism should be considered a red flag for symptoms related to psychological distress in patients with non-cardiac chest pain

Keywords

Chest pain Children Pediatric emergency department 

Abbreviations

ED

Emergency department

Notes

Acknowledgments

We thank Dr. Martina Bradaschia for the review of this manuscript.

Authors’ contributions

V Gesuete: project development, data collection and management, manuscript writing

D Fregolent: data collection

S Contorno: data collection

G Tamaro: data collection

E Barbi: project development, manuscript editing

G Cozzi: manuscript editing

Compliance with ethical statements

Conflict of interest

The authors declare that they have no conflict of interest

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Angoff GH, Kane DA, Giddins N et al (2013) Regional implementation of a pediatric cardiology chest pain guideline using SCAMPs methodology. Pediatrics 132:e1010–e1017CrossRefGoogle Scholar
  2. 2.
    Cava JR, Sayger PL (2004) Chest pain in children and adolescents. Pediatr Clin North Am 51:1553–1568CrossRefGoogle Scholar
  3. 3.
    Cozzi G, Minute M, Skabar A, Pirrone A, Jaber M, Neri E, Montico M, Ventura A, Barbi E (2017 Apr) Somatic symptom disorder was common in children and adolescents attending an emergency department complaining of pain. Acta Paediatr 106(4):586–593CrossRefGoogle Scholar
  4. 4.
    Driscoll DJ, Glicklich LB, Gallen WJ (1976) Chest pain in children: a prospective study. Pediatrics 57(5):648–651PubMedGoogle Scholar
  5. 5.
    Drossner DM, Hirsh DA, Sturm JJ, Mahle WT, Goo DJ, Massey R, Simon HK (2011) Cardiac disease in pediatric patients presenting to a pediatric ED with chest pain. Am J Emerg Med 29(6):632–638CrossRefGoogle Scholar
  6. 6.
    Evangelista JA, Parsons M, Renneburg AK (2000) Chest pain in children: diagnosis through history and physical examination. J Pediatr Health Care 14(1):3–8CrossRefGoogle Scholar
  7. 7.
    Feinstein AB, Sturgeon JA, Darnall BD, Dunn AL, Rico T, Kao MC et al (2017) The effect of pain catastrophizing on outcomes: a developmental perspective across children, adolescents, and young adults with chronic pain. J Pain 18(2):144–154CrossRefGoogle Scholar
  8. 8.
    Friedman KG, Kane DA, Rathod RH et al (2011) Management of pediatric chest pain using a standardized assessment and management plan. Pediatrics 128:239–245CrossRefGoogle Scholar
  9. 9.
    Friedman KG et al (2011) Management of pediatric chest pain using a standardized assessment and management pain. Pediatrics 128:239–245CrossRefGoogle Scholar
  10. 10.
    Fyfe DA et al (1984) Chest pain in pediatric patients presenting to a cardiac clinic. Clin Pediatr 23:321–324CrossRefGoogle Scholar
  11. 11.
    Geggel RL (2004) Conditions leading to pediatric cardiology consultation in a tertiary academic hospital. Pediatrics 114:409–417CrossRefGoogle Scholar
  12. 12.
    Holm S, Ljungman G, Söderlund A (2012) Pain in children and adolescents in primary care; chronic and recurrent pain is common. Acta Paediatr 101:1246–1252CrossRefGoogle Scholar
  13. 13.
    Ives A et al (2010) Recurrent chest pain in the well child. Arch Dis Child 95:649–654CrossRefGoogle Scholar
  14. 14.
    Katz F, Leith E, Paliokosta E (2016) Fifteen-minute consultation for a child not attending school: a structured approach to schoolrefusal. Arch Dis Child Educ Pract Ed 101(1):21–25CrossRefGoogle Scholar
  15. 15.
    Linch LH et al (2008) Children with chest pain visiting the emergency department. Pediatr Neonatol 49(2):26–29CrossRefGoogle Scholar
  16. 16.
    Lipsitz JD et al (2004) Anxiety and depressive symptoms and anxiety sensitivity in youngsters with non cardiac chest pain. Pediatr Psychol 29:607–612CrossRefGoogle Scholar
  17. 17.
    Lipsitz JD, Gur M, Sonnet FM, Dayan PS, Miller SZ, Brown C, Sherman B (2010) Psychopathology and disability in children with unexplained chest pain presenting to the pediatric emergency department. Pediatr Emerg Care 26(11):830–836CrossRefGoogle Scholar
  18. 18.
    Massin MM et al (2004) Chest pain in pediatric patients presenting to an emergency department or to a cardiac unit. Clin Pediatr 43:231–238CrossRefGoogle Scholar
  19. 19.
    Pantell RH et al (1983) Adolescent chest pain: a prospective study. Pediatrics 71:881–887PubMedGoogle Scholar
  20. 20.
    Rowe BH et al (1990) Characteristics of children presenting with chest pain to a pediatric emergency department. Can Med Assoc J 143:388–394Google Scholar
  21. 21.
    Rowe BH, Dulberg CS, Peterson RG, Vlad P, Li MM (1990) Characteristics of children presenting with chest pain to a pediatric emergency department. CMAJ 143(5):388–394PubMedPubMedCentralGoogle Scholar
  22. 22.
    Selbst SM (1985) Chest pain in children. Pediatrics 75:1068–1070PubMedGoogle Scholar
  23. 23.
    Selbst SM, Ruddy RM, Clark BJ et al (1988) Pediatric chest pain: a prospective study. Pediatrics 82:319–323PubMedGoogle Scholar
  24. 24.
    Selbst SM et al (1990) Chest pain in children. Follow-up of patients previously reported. Clin Pediatr 29:374–377CrossRefGoogle Scholar
  25. 25.
    Tunaoglu FS, Olguntürk R, Akcabay S, Oguz D, Gücüyener K, Demirsoy S (1995) Chest pain in children referred to a cardiology clinic. Pediatr Cardiol 16(2):69–72CrossRefGoogle Scholar
  26. 26.
    Varni JW et al (2001) PedsQL 4.0: reliability and validity of the PediatricQuality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care 39:800–812CrossRefGoogle Scholar
  27. 27.
    Verghese GR, Friedman KG, Rathod RH et al (2012) Resource utilization reduction for evaluation of chest pain in pediatrics using a novel standardized clinical assessment and management plan (SCAMP). J Am Heart Assoc 1Google Scholar
  28. 28.
    Zavaras-Angelidou KA et al (1992) Review of 180 episodes of chest pain in 134 children. Pediatr Emerg Care 8(4):189–193CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Cardiology ServiceInstitute for Maternal and Child Health - IRCCS “Burlo Garofolo”TriesteItaly
  2. 2.University of TriesteTriesteItaly
  3. 3.Pediatric Emergency DepartmentInstitute for Maternal and Child Health - IRCCS “Burlo Garofolo”TriesteItaly

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