Chest Pain in Pediatric Emergency Care: A Retrospective Analysis of Causes and Using of Electrocardiogram

Background: Chest pain is a relatively common and worrisome symptom in children often causing admission to emergency care. Estimated frequency ranges between 0,3-0,6%. In the majority of cases the etiology is benign, differently to adults.

Objective: The aim of the study is to identife the most frequent causes of this symptom and the role of electrocardiogram (ECG) in the diagnostic process.

Methods: Retrospective case series of patients admitted to our pediatric emergency service was carried out to determine patients characteristic, risk factors, and diagnostic and therapeutical approach. Elegible patients were children from 3 months to 16 years of age admitted between 01/2006 and 12/2015. Descriptive analysis was performed to characterize the study population. Chi-square, Mann-Whitney U test or Fisher’s exact test were used for comparison between groups as appropriate. Logistic regression was used to estimate odds ratios and 95% confidence intervals for all potential predictors.

Results: 1078 patients (0.67% of total admission) were enrolled: 604 (56,03%) were male, mean age (SD) at presentation was 9,8 years + 3,7. Six different diagnostic cathegories were idientified: musculoskeletal in 707 patients (68,57%), abdominal (13,39%), psychosomatic (8,34%) and respiratory (6,50%); cardiac origin was founded only in 31 patients (3,01%) and other causes in 2 patients (0,02). Cardiac or respiratory physical exam alterations were predictive of a cardiac cause (RR 16.72 p<0.0001), or a respiratory cause (RR 25.58 p<0.0001). The ECG was performed in 794 patients (73,65%) and showed alterations in 31 cases; all of them were admitted for a cardiac symptom (palpitation) or sign (p < 0.0001).

Conclusion: Thoracic pain is a common complaint and rarely related with cardiac disorders. A physical examination is sufficient, in the vast majority of cases, to exclude a serious origin for the pain. Target diagnostic exams should be performed in selected patients.