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Pediatric And Adolescent Chest Pain

August 2007

The skilled emergency clinician will not dismiss the complaint of chest pain because of the impression that it is rarely serious. While it is true that most children complaining of chest pain do not have a life-threatening condition, there are notable exceptions. The mandate of the emergency physician is to identify the child with a life-threatening condition in a sea of benignity. The purpose of this article, therefore, is to present an overview of the many causes of chest pain in children which should be considered, even if most can be excluded through a careful history and physical exam. What remains undiagnosed cannot be treated. While this review will focus and place disproportionate emphasis on serious causes of pediatric chest pain, the low likelihood of these diseases should be kept in context. Reassurance is important after the evaluation, and close attention should be paid to what are frequently subtle clues in the history, on the physical exam, and in the few diagnostic tests likely to be ordered in the emergency department. As with many conditions presenting to the emergency department, even if the likelihood of serious disease may be small, the implication of misdiagnosis is extremely high (e.g., aortic dissection, subarachnoid hemorrhage, meningococcemia).
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