title: Regional implementation of a pediatric cardiology chest pain guideline using SCAMPs methodology.
abstract: OBJECTIVE
  Chest pain is a complaint for which children are frequently evaluated. Cardiac causes are rarely found despite expenditure of considerable time and resources. We describe validation throughout New England of a clinical guideline for cost-effective evaluation of pediatric patients first seen by a cardiologist for chest pain using a unique methodology termed the Standardized Clinical Assessment and Management Plans (SCAMPs).
  
  
  METHODS
  A total of 1016 ambulatory patients, ages 7 to 21 years initially seen for chest pain at Boston Children's Hospital (BCH) or the New England Congenital Cardiology Association (NECCA) practices, were evaluated by using a SCAMPs chest pain guideline. Findings were analyzed for diagnostic elements, patterns of care, and compliance with the guideline. Results from the NECCA practices were compared with those of Boston Children's Hospital, a regional core academic center.
  
  
  RESULTS
  Two patients had chest pain due to a cardiac etiology, 1 with pericarditis and 1 with an anomalous coronary artery origin. Testing performed outside of guideline recommendations demonstrated only incidental findings. Patients returning for persistent symptoms did not have cardiac disease. The pattern of care for the NECCA practices and BCH differed minimally.
  
  
  CONCLUSIONS
  By using SCAMPs methodology, we have demonstrated that chest pain in children is rarely caused by heart disease and can be evaluated in the ambulatory setting efficiently and effectively using minimal resources. The methodology can be implemented regionally across a wide range of clinical practice settings and its approach can overcome a number of barriers that often limit clinical practice guideline implementation.
authors.affiliation: Cardiology Outpatient Services, Department of Cardiology, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115. david.fulton@cardio.chboston.org.
authors.forename: Gerald H
authors.initials: GH
authors.lastname: Angoff
authors.forename: David A
authors.initials: DA
authors.lastname: Kane
authors.forename: Niels
authors.initials: N
authors.lastname: Giddins
authors.forename: Yvonne M
authors.initials: YM
authors.lastname: Paris
authors.forename: Adrian M
authors.initials: AM
authors.lastname: Moran
authors.forename: Victoria
authors.initials: V
authors.lastname: Tantengco
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Rotondo
authors.forename: Lucy
authors.initials: L
authors.lastname: Arnold
authors.forename: Olga H
authors.initials: OH
authors.lastname: Toro-Salazar
authors.forename: Naomi S
authors.initials: NS
authors.lastname: Gauthier
authors.forename: Estella
authors.initials: E
authors.lastname: Kanevsky
authors.forename: Ashley
authors.initials: A
authors.lastname: Renaud
authors.forename: Robert L
authors.initials: RL
authors.lastname: Geggel
authors.forename: David W
authors.initials: DW
authors.lastname: Brown
authors.forename: David R
authors.initials: DR
authors.lastname: Fulton
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000379:methods; D002637:Chest Pain / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D002648:Child; D019468:Disease Management; D004452:Echocardiography / Q000379:methods / Q000592:standards*; D004562:Electrocardiography / Q000379:methods / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006331:Heart Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000379:methods*; D017410:Practice Guidelines as Topic / Q000592:standards*; D013902:Radiography, Thoracic / Q000592:standards; D055815:Young Adult
keywords: SCAMPs; chest pain; clinical practice guideline; pediatric cardiology