Chest pain in pediatric patients presenting to an emergency department or to a cardiac clinic.
The aim of this study was to assess the epidemiology of chest pain among unselected Belgian children referred to an emergency department or to a cardiology clinic.


METHODS
We analyzed the etiology to chest pain and the diagnostic workup of 168 consecutive pediatric patients, seen in our emergency department with the primary diagnosis of chest pain over a 5-year period (group A). Simultaneously a sample of 69 consecutive pediatric patients referred to the cardiology clinic by primary care physicians with the same chief complaint was prospectively included in the study (group B).


RESULTS
Chest wall pain was the most common diagnosis in the group A (64%). Other causes included pulmonary (13%), psychological (9%), cardiac (5%), traumatic (5%), and gastrointestinal problems (4%). The organic causes were easily identified or suspected by history and physical examination. Chest radiography, electrocardiography, and blood analysis were performed in most patients with suspected nonorganic chest pain but in no case were organic diseases diagnosed by those ancillary studies. In group B, chest wall pain was also the most common diagnosis (89%). Supraventricular tachyarrhythmia and exercise-induced asthma were demonstrated in 5 (7%) and 3 patients (4%), respectively. The most important tools in assessing a child with acute chest pain in an emergency department are thorough history and physical examination. Assessment of recurrent chest pain is more difficult; arrhythmia, and allergic and exercise-induced asthma may be underestimated when investigations are not performed.
Massin
Martial M
MM
Department of Pediatrics, University of Liège, Belgium.
Bourguignont
Astrid
A
Coremans
Christine
C
Comté
Laetitia
L
Lepage
Philippe
P
Gérard
Paul
P
D000293:Adolescent; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D001530:Belgium / Q000453:epidemiology; D002637:Chest Pain / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D002648:Child; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies