Abstract
Aims: Chest pain is a common complaint at pediatric cardiology clinics and often leads to an extensive cardiac evaluation. In this study, we analyzed the causes of chest pain in Chinese children and developed diagnostic procedures and criteria for targeted myocardial enzyme testing.Methods and Results: We retrospectively analyzed the clinical data of patients aged below 18 years visiting our hospital for chest pain between 2005 and 2019. Based on auxiliary exams and clinical diagnosis, we developed diagnostic procedures and criteria for targeted myocardial enzyme testing in children with chest pain. A total of 7,251 children were included in this study. The chest pain was of cardiac origin in 581 patients (8.0%). The incidence of non-cardiac chest pain was significantly higher in the preschool group and the school-age group than in the adolescent group (93.5 vs. 93.8 vs. 90.3%, P < 0.05). Among children with cardiac chest pain, the most common concomitant symptom was chest tightness (67.0%). Myocardial enzyme testing was performed in 5,408 patients and was abnormal in 453 patients. We developed a diagnostic procedure and criteria for targeted myocardial enzyme testing using pertinent history, physical examination, and ECG findings or UCG finding. Applying the diagnostic procedure and criteria could lead to the reduction in myocardial enzyme testing while still capturing all cardiac diagnoses.Conclusion: In children, chest pain is mostly benign and rarely cardiac. During diagnosis, targeted myocardial enzyme testing based on medical history and physical examination can effectively reduce resource use.
Highlights
Chest pain is a common complaint at pediatric clinics, accounting for ∼6 per 1,000 visits at pediatric emergency room [1], as well as ∼1 per 40 visits at pediatric clinics in the UK [2], To date, no large studies have been conducted to investigate this topic in Chinese children
We developed diagnostic procedures and criteria for targeted myocardial enzyme testing in children with chest pain based on this retrospective study and the diagnostic procedures for chest pain in children from literature reports [10, 15, 17,18,19]
The incidence of non-cardiac chest pain was significantly higher in the preschool group and the schoolage group than in the adolescent group (93.5 vs. 93.8 vs. 90.3%, P < 0.05) (Table 5)
Summary
Chest pain is a common complaint at pediatric clinics, accounting for ∼6 per 1,000 visits at pediatric emergency room [1], as well as ∼1 per 40 visits at pediatric clinics in the UK [2], To date, no large studies have been conducted to investigate this topic in Chinese children. It is important to investigate common causes of chest pain in children and develop diagnostic procedures in order to reduce stress to children and their families. In 2011, Friedman et al [15] investigated the use of echocardiography (UCG) for the diagnosis of chest pain in children and developed diagnostic and treatment procedures based on medical history, physical examination, and electrocardiogram (ECG). No studies have investigated targeted cardiac enzyme testing for the diagnosis of chest pain in children. It is important to develop the criteria for targeted myocardial enzyme testing in children with potential cardiac chest pain in order to reduce the economic burden on their families and reduce resource use. We analyzed the common causes of chest pain in children and the pattern of clinical visits and developed diagnostic procedures and criteria for targeted myocardial enzyme testing
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