G246(P) Children with Chest Pain - A Cause For Anxiety But is It an Emergency?

Abstract

Background Chest pain (CP) in children is a common complaint in emergency departments, general paediatric clinics, and paediatric cardiology clinics. It can be a source of anxiety for parents, patient and physicians and can lead to a school and sports absenteeism. A thorough history and physical examination usually can determine the cause and differentiate patients who require acute intervention from those who can be managed with advice and reassurance. Aim To review the presentation, and management of children presenting with chest pain to a tertiary level teaching hospital over a 12 month period. To assess diagnosis, investigations, treatment and follow up. Methods Retrospective data was collected on all children attending emergency department with triage complaint of chest pain using the Emergency department Information system. Results 134 children were identified Mean age: 11.66 years [range: 3-16years].80(60%) were male and 54(40%) were females. Median duration of chest pain was 2 days and half of children presented within 48 hours of pain onset. Documentation was poor with no recorded history of cough, fever or shortness of breath in almost half of the presentations. The following specific cardiac symptoms were not recorded; radiation to arm (73.9%), Radiation to back (76%), Dizziness (82%), Collapse (88%) and Palpitations (73%). No mention drug abuse in 100% Examination findings revealed 93% had no murmur and 99.3% had normal O2 Sats on arrival. Investigations - ECG in 82% and was abnormal in 6%. Chest X-ray in 77% and it was abnormal in 10%. FBC was abnormal in <1% of patients. Troponin was done in 17% and none of these had abnormal result. D-Dimer was raised in only 2 out of 6 patients (1.5%). Most Common Diagnoses were Musculoskeletal 26.9%, Costochondritis 23.1% Idiopathic 14.1% and Pneumonia 8.2%.Only 1 child had cardiac diagnosis 0.8% required admission while 92% were discharged home. Conclusions Review of 1 year of ED visits revealed that CP in children is a reasonably common complaint and is associated with tremendous anxiety and resource utilisation. There is a need for better documentation of history and examination findings. Yield from Investigations is low and should be reserved for at risk patients.