Effectiveness of screening for life-threatening chest pain in children

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.