Pediatric chest pain is a relatively common presenting complaint, but identifying serious pathologies without overtesting patients with less-serious pathologies can be a challenge for emergency clinicians. This issue reviews the available literature to provide evidence-based recommendations to support a more standardized approach to the evaluation and management of pediatric patients with chest pain. This issue will help the emergency clinician identify red flags associated with cardiac causes of pediatric chest pain, recognize life-threatening causes of cardiac and non–cardiac chest pain, clinically diagnose the most common causes of non–cardiac chest pain, and appropriately utilize diagnostic tests in the evaluation of chest pain patients.
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Following are the most informative references cited in this paper, as determined by the authors.
1. * Drossner DM, Hirsh DA, Sturm JJ, et al. Cardiac disease in pediatric patients presenting to a pediatric ED with chest pain. Am J Emerg Med. 2011;29(6):632-638. (Retrospective study; 4288 patients) DOI: 10.1016/j.ajem.2010.01.011
2. * Mohan S, Nandi D, Stephens P, et al. Implementation of a clinical pathway for chest pain in a pediatric emergency department. Pediatr Emerg Care. 2018;34(11):778-782. (Retrospective study; 1687 patients) DOI: 10.1097/pec.0000000000000861
4. * Selbst SM, Ruddy RM, Clark BJ, et al. Pediatric chest pain: a prospective study. Pediatrics. 1988;82(3):319-323. (Prospective study; 407 patients) DOI: 10.1542/peds.82.3.319
44. * Babbitt CJ, Babbitt MJ, Byrne F, et al. Pediatric myopericarditis presenting to the emergency department as chest pain: a comparative study with myocarditis. Pediatr Emerg Care. February 12, 2021. (Retrospective study; 36 patients) DOI: 10.1097/pec.0000000000002376
50. * Dalal A, Czosek RJ, Kovach J, et al. Clinical presentation of pediatric patients at risk for sudden cardiac arrest. J Pediatr. 2016;177:191-196. (Retrospective chart review; 450 patients) DOI: 10.1016/j.jpeds.2016.06.088
110. *Brancato F, De Rosa G, Gambacorta A, et al. Role of troponin determination to diagnose chest pain in the pediatric emergency department. Pediatr Emerg Care. 2021;37(12):e1589-e1592. (Retrospective observational study; 99 patients) DOI: 10.1097/pec.0000000000002123
113. *Neff J, Anderson M, Stephenson T, et al. REDUCE-PCP study: radiographs in the emergency department utilization criteria evaluation-pediatric chest pain. Pediatr Emerg Care. 2012;28(5):451-454. (Retrospective chart review study; 400 patients) DOI: 10.1097/PEC.0b013e31825355b5
121. *Kanis J, Pike J, Hall CL, et al. Clinical characteristics of children evaluated for suspected pulmonary embolism with D-dimer testing. Arch Dis Child. 2018;103(9):835-840. (Retrospective study; 526 patients) DOI: 10.1136/archdischild-2017-313317
123. *Kanis J, Hall CL, Pike J, et al. Diagnostic accuracy of the D-dimer in children. Arch Dis Child. 2018;103(9):832-834. (Retrospective study; 2554 patients) DOI: 10.1136/archdischild-2017-313315
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Keywords: chest pain, cardiac chest pain, noncardiac chest pain, myocarditis, pericarditis, myopericarditis, perimyocarditis, hypertrophic cardiomyopathy, anomalous aortic origin of a coronary artery, AAOCA, aortic dissection, arrhythmia, electrocardiogram, biomarkers, chest radiography, chest x-ray
Jay D. Fisher, MD, FAAP, FACEP; Beth Warren, DO
Nicole Gerber, MD; Catherine E. Perron, MD
February 2, 2022
March 1, 2025
Date of Original Release: February 1, 2022. Date of most recent review: January 15, 2021. Termination date: February 1, 2025.
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