Study shows children’s chest pains rarely a concern

The researchers, led by cardiologist Dr. Susan Saleeb from Children’s Hospital in Boston, looked at 3,700 cases of chest pain in children and young adults between 7 and 22 years of age that were treated at Children’s Hospital between 2000 and 2009. Of these cases, only one percent, or 37 cases, revealed a cardiac cause and none of these resulted in death.

The breakdown of the results showed that musculoskeletal distress was responsible for 1,345 cases, 242 were pulmonary, 108 were gastrointestinal, 34 were anxiety and four were drug-related. However, there were 1,928 cases where physicians were unable to determine a cause.

Despite the lack of results linking these chest pains to cardiac issues, clinics have seen an increase in children being brought in for cardiac screenings. Within the 10-year period this study was conducted, clinics saw an increase from an average 240 patients jump to nearly 500. The researchers believe the increased concerns by parents can be attributed to the highly publicized cases where child athletes have died from apparent cardiac conditions. However, the estimated incidence of cardiac deaths in children is only 0.6 to 6.2 per 100,000.

While chest pain in adults is usually a strong indication of cardiovascular disease, the same pains in children is usually not cause for alarm. However, many of these children have undergone costly tests to rule out cardiac involvement. Doctors are now advised to use a chest pain guideline known as SCAMP to rule out patients that do not need unnecessary testing. Children are screened initially based on symptoms, family history, physical exam and an EKG. If abnormalities are noted, then further testing is advised. This initial screening could eliminate unnecessary referrals to cardiologists.

Saleeb does note that certain “red flags” such as chest pain that occurs during exercise, an irregular heartbeat or fainting should be evaluated immediately.

More information: Effectiveness of Screening for Life-Threatening Chest Pain in Children, Pediatrics, Published online October 10, 2011, doi:10.1542/peds.2011-0408

ABSTRACT
Objective: We sought to determine the incidence of sudden cardiac death among patients discharged from the cardiology clinic with presumed noncardiac chest pain (CP).
Methods: The records of children >6 years of age who presented to Children's Hospital Boston between January 1, 2000, and December 31, 2009, with a complaint of CP were reviewed for demographic features, clinical characteristics, resource utilization, and presumed diagnosis. Patients were searched for in the US National Death Index and Social Security Death Index.
Results: Data for a total of 3700 patients with CP (median age at evaluation: 13.4 years [range: 7–22.3 years]) were reviewed. The median follow-up period was 4.4 years (range: 0.5–10.4 years), for total of 17 886 patient-years of follow-up data. CP with exertion occurred in 1222 cases (33%), including 15 with associated syncope. A cardiac cause was determined in 37 cases; the remaining 3663 patients (99%) had CP of unknown (n = 1928), musculoskeletal (n = 1345), pulmonary (n = 242), gastrointestinal (n = 108), anxiety-related (n = 34), or drug-related (n = 4) origin. Emergency department visits for CP were documented for 670 patients (18%), and 263 patients (7%) had cardiology follow-up visits related to CP. There were 3 deaths, including 2 suicides and 1 spontaneous retroperitoneal hemorrhage.
Conclusion: CP in children is a common complaint and rarely has a cardiac cause. Review of 1 decade of cardiology visits (nearly 18 000 patient years) revealed that no patient discharged from the clinic died as a result of a cardiac condition.

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