Paediatric Chest Pain in the Emergency Department
CPS ePoster Library. Wong R. Jun 25, 2015; 99226; 165
Rachel Wong
Rachel Wong
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Abstract
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Objective: To establish poor predictive value and over-use of diagnostic testing in pediatric patients presenting with chest pain.

Methods: This retrospective study included children aged 0 to 18 years presenting to emergency department (ED) with the chief complaint of chest pain from January 2012 to January 2014. Charts were analyzed for sex, age at presentation, associated symptoms, past cardiac history, investigations in the ED, diagnosis at discharge, and outpatient echocardiogram and Holter monitor findings at follow-ups.

Results: Of the 473 visits, 80 had previous cardiac history. 65% (n=307) of patients received chest x-ray, with only 3% (n=9) had an abnormal finding, and five (1.6%) that changed management. Electrocardiogram was done in 76% (n=358) of the patients, and 24% (n=85) of the results were abnormal, with only one that changed management. Within six months following discharge, 75 (16%) patients received echocardiogram, 30 of which had no previous cardiac history, and normal or no ECG in the ED. The echocardiograms yielded only 2 cases of newly diagnosed mitral valve prolapse, and one case of small patent ductus arteriosus. 50 patients (11%) received Holter monitoring within six months following discharge, 20 of whom had no previous cardiac history, and had normal or no ECGs in the ED.

Conclusions: This is the largest pediatric review of chest pain in Canada in published literature. Chest pain in the pediatric population are rarely due to cardiac causes, but most patients still receive unnecessary investigations in the ED, and in outpatient settings following their ED visit.
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