Characteristics and outcomes of children presenting to an emergency department with chest pain

Abstract

BACKGROUND: Chest pain is a frequent presenting complaint to the paediatric emergency department. Although most cases are benign in aetiology, children are still extensively investigated. This study aims to assess whether cardiac risk factors in children with nontraumatic chest pain presenting to paediatric emergency department are appropriately identified and investigated, to review use of cardiac biomarkers and to audit documentation of cardiac risk factors.

METHODS: Risk factors in history and examination were identified from international guidelines. Chi tests were used to compare rates of investigations in patients with red flags versus those without. Yield of investigations and documentation for risk factors were also assessed.

RESULTS: A total of 130 children were included, median age 12 years. There were no significant differences in investigation rates between patients with cardiac risk factors (n = 92) and those without (n = 38). Yield from all investigations was minimal. Documentation was poor, with less than two thirds documentation rate for any cardiac risk factor.

CONCLUSION: Our study confirms that chest pain in children is usually due to benign causes. The yield of blanket laboratory investigations is limited. We suggest a clinical pathway to improve documentation and rationalise use of investigations in children presenting with chest pain to the emergency department.