Chest Pain in Children and Adolescents: Reality of an Emergency Department

Background: Chest pain is a common complaint in children/adolescents visiting the emergency department (ED). The existence of underlying heart disease is rarely verified. It is mostly idiopathic, and in adolescence the psychogenic etiology assumes greater expressiveness.

Objective and Methods: Retrospective analysis of the clinical processes of patients who visited the ED between December 2017 and May 2018 with chest pain. Cases of traumatic etiology were excluded.

Results: A total of 175 children/adolescents (52% girls; median age 13 years) attended the ED. Five percent had cardiovascular antecedents, and 7% psychiatric. Regarding pain characteristics, the majority lasted between 1 hour and 1 day (27%), with preferential retrosternal location (18%) or in the left hemithorax (18%). Associated symptoms occurred in 69% of patients, including 5% of palpitations and 5% of paresthesias in the left upper limb. Physical examination revealed no abnormalities in 39% of patients, 25% reported chest wall tenderness and 5% had altered cardiac auscultation. Eleven percent reported at least one stressful event associated with the onset of chest pain. Fifty-seven percent had chest X-ray (16% altered), 23% electrocardiogram (7% altered), 51% cardiac enzymes (2% altered) and 32% did not perform any additional investigation. Regarding the final diagnosis, 38% was idiopathic, 29% respiratory, 17% musculoskeletal, 14% psychogenic and 2% cardiac. Concerning psychogenic pain, there was a statistically significant relationship with the adolescence phase, female sex and the presence of previous stressful events (p <0.05). Two percent of the patients were admitted in the pediatric unit and 2% were transferred to a cardiovascular reference center.

Conclusion: The number of children/adolescents who were admitted due to chest pain, highlights the importance of the characterization of this population. Cases of cardiac etiology are rare and it is therefore essential to give young people and families a sense of security in the absence of serious illness.