Evaluation of Chest Pain in the Pediatric Patient

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Epidemiology

Chest pain accounts for approximately 0.3% to 0.6% of pediatric emergency department (ED) visits.1, 2, 3 The frequency of visits is fairly constant throughout the year,4 with a slight excess in summer months reported in one study.1

In EDs treating children up to 18 years of age, the median age for presentation with chest pain was 12 to 13 years.1, 5, 6 The reported male to female ratio is fairly even, ranging from 1:1 to 1.6:1.1, 5, 6 In adolescents, relatively more girls present with chest pain.

Causes of chest pain in children

Most of what is known about frequency of various causes of pediatric chest pain comes from studies performed in pediatric EDs and cardiology clinics. Table 1 provides a list of frequencies of causes according to organ system. In general, the most frequent cause reported is musculoskeletal pain, including costochondritis. These conditions represent between 7% and 69% of cases presenting to an ED, with the reported frequency dependent somewhat on how strictly musculoskeletal pain is defined and

Approach to the pediatric patient with chest pain

The primary goals in evaluation of a child with chest pain are to rule out cardiac and other serious causes and to classify the origin of the pain. A thorough history and physical examination are often sufficient to accomplish these goals. In cases in which the cause remains unclear or if concerning features are identified, further evaluation and sometimes referral are warranted.

Summary

Chest pain is common in children seen in EDs, ambulatory clinics, and cardiology clinics. Although most children have a benign cause for their pain, some have serious and life-threatening conditions. The symptom must be carefully evaluated before reassurance and supportive care are offered. Because serious causes of chest pain are uncommon and not many prospective studies are available, it is difficult to develop evidence-based guidelines for evaluation. The clinician evaluating a child with

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