title: Pediatric Chest Pain-Low-Probability Referral: A Multi-Institutional Analysis From Standardized Clinical Assessment and Management Plans (SCAMPs®), the Pediatric Health Information Systems Database, and the National Ambulatory Medical Care Survey.
abstract: We conducted a study to assess test characteristics of red-flag criteria for identifying cardiac disease causing chest pain and technical charges of low-probability referrals. Accuracy of red-flag criteria was ascertained through study of chest pain Standardized Clinical Assessment and Management Plans (SCAMPs®) data. Patients were divided into 2 groups: Group1 (concerning clinical elements) and Group2 (without). We compared incidence of cardiac disease causing chest pain between these 2 groups. Technical charges of Group 2 were analyzed using the Pediatric Health Information System database. Potential savings for the US population was estimated using National Ambulatory Medical Care Survey data. Fifty-two percent of subjects formed Group 1. Cardiac disease causing chest pain was identified in 8/1656 (0.48%). No heart disease was identified in patients in Group 2 ( P = .03). Applying red-flags in determining need for referral identified patients with cardiac disease causing chest pain with 100% sensitivity. Median technical charges for Group 2, over a 4-year period, were US2014$775 559. Eliminating cardiac testing of low-probability referrals would save US2014$3 775 182 in technical charges annually. Red-flag criteria were an effective screen for children with chest pain. Eliminating cardiac testing in children without red-flags for referral has significant technical charge savings.
authors.affiliation: 1 Children's National Health System, Washington, DC, USA.|2 George Washington University, Washington, DC, USA.
authors.forename: Ashraf S
authors.initials: AS
authors.lastname: Harahsheh
authors.affiliation: 1 Children's National Health System, Washington, DC, USA.|2 George Washington University, Washington, DC, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: O'Byrne
authors.affiliation: 1 Children's National Health System, Washington, DC, USA.
authors.forename: Bill
authors.initials: B
authors.lastname: Pastor
authors.affiliation: 3 Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Dionne A
authors.initials: DA
authors.lastname: Graham
authors.affiliation: 3 Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Fulton
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000191:economics / Q000379:methods; D002309:Cardiology / Q000191:economics / Q000379:methods*; D002318:Cardiovascular Diseases / Q000150:complications / Q000175:diagnosis*; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D002648:Child; D016208:Databases, Factual; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D010372:Pediatrics / Q000191:economics / Q000379:methods*; D017410:Practice Guidelines as Topic; D011336:Probability; D058996:Quality Improvement; D012017:Referral and Consultation; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014481:United States
keywords: chest pain; pediatric cardiology; quality improvement; subspecialty referral