[Chest pain in pediatric emergency departments: a usually benign process].

OBJECTIVES: To describe the characteristics and management of the children aged less than 14 years presenting to the pediatric emergency department with chest pain.

PATIENTS AND METHOD: Retrospective review of all the patients who presented to the pediatric emergency department with chest pain from 15 January 2001 to 14 January 2002. Families received a follow-up telephone call inquiring about the patient's outcome. The Mann-Whitney U test was used for non-parametric data and the Chi-square test with Yates' correction and Fisher's exact test were used for categorical data. Statistical significance was set at p<0.05.

RESULTS: In 2001, 161 children presented with chest pain, representing 0.34% of the total number of consultations. Less than half of these patients (48%) had associated symptoms. Physical examination revealed abnormalities in 63% of the patients (39.1%). The most common finding was pain on palpation of the chest wall. Additional diagnostic tests were performed in 129 patients (80%). These included 116 radiographs, 62 electrocardiograms and nine miscellaneous tests. Abnormalities were found in seven chest radiographs. Only one child was admitted to hospital with pneumonia. The most common discharge diagnoses were idiopathic and/or musculoskeletal chest pain in 139 patients, pain of respiratory origin in 14 patients, gastrointestinal disorders in one patient, cardiac problems in one patient and other morbid processes in nine patients. Children with associated symptoms were more likely to receive a diagnosis other than nonspecific chest pain (28% vs 3.2% in children without other symptoms; relative risk: 8.66). Outpatient treatment included analgesics in 105 patients (65.2%). Only two children (1.2%) returned for reevaluation and no important findings were detected. Telephone follow-up was carried out in 117 children (72.6%). The pain lasted for less than 24 hours in 52 patients (32.2%). Thirty percent of the patients missed at least one day of school because of chest pain.

CONCLUSIONS: Chest pain is an infrequent chief complaint in our setting and, in the absence of associated symptoms, is not generally associated with serious disorders. The decision to use complementary diagnostic tests should be individualized to each patient.