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. 2023 Nov 28;12(11):2010-2019.
doi: 10.21037/tp-23-230. Epub 2023 Nov 21.

Chest pain attendances to a Paediatric Emergency Department pre- and post-COVID-19 vaccination

Joyce Ziwei Tan  1 , Dyan Zhewei Zhang  2   3 , Sreekanthan Sundararaghavan  2   3 , Sashikumar Ganapathy  1   3 , Jonathan Tze Liang Choo  2   3 , Maehanyi Frances Rajendram  4 , Shu-Ling Chong  1   3
Affiliations

Chest pain attendances to a Paediatric Emergency Department pre- and post-COVID-19 vaccination

Joyce Ziwei Tan et al. Transl Pediatr. .

Abstract

Background: Introduction of the mRNA vaccination for coronavirus disease 2019 (COVID-19) has been associated with an increase in cases of peri/myocarditis. In our retrospective cross-sectional study, we aim to (I) describe paediatric chest pain attendance, and (II) study resource utilisation in the Emergency Department (ED) of KK Women's and Children's Hospital (KKH), stratified by pre-pandemic, during the pandemic pre- and post-COVID vaccination introduction in adolescents.

Methods: We reviewed records of adolescents aged 12 to 18 years old who presented to our ED with the triage complaint of chest pain between 1 January 2019 to 31 January 2022, and determined the attendance rates, aetiologies and resource utilisation during the above time periods.

Results: There were 2,418 ED attendances for chest pain in our study population. Among 887 inpatient admissions for chest pain, 1.8% were attributed to a cardiac cause. Comparing the pre-pandemic period to the period after the mRNA COVID-19 vaccination was introduced, ED chest pain rates increased from a median of 0.5% of ED attendances [interquartile range (IQR), 0.3-0.5%] to 0.9% (IQR, 0.7-2.0%) (P<0.001), while admission rates increased from a median of 26.2% of ED attendances (IQR, 24.1-29.1%) to 40.9% (IQR, 37.6-56.6%) (P<0.001). Cardiac enzyme orders among ED visits for chest pain increased from a pre-pandemic median of 0% (IQR, 0.0-2.6%) to a post-vaccination median of 26.1% (IQR, 17.2-56.2%) (P<0.001) and were due to concerns for vaccine-related myocarditis. Seven cases of probable vaccine-related myocarditis presented with chest pain to our ED.

Conclusions: Paediatric chest pain is largely non-cardiac in origin. ED chest pain attendance rates and resource utilisation increased after the introduction of mRNA COVID-19 vaccination in adolescents.

Keywords: Chest pain; mRNA coronavirus disease 2019 vaccination (mRNA COVID-19 vaccination); myocarditis; paediatric emergency.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-23-230/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Monthly chest pain attendance among total ED attendances. ED, Emergency Department; COVID-19, coronavirus disease 2019.
Figure 2
Figure 2
Incidence of myocarditis/pericarditis in adolescents presenting with chest pain. COVID-19, coronavirus disease 2019.
Figure 3
Figure 3
Resource utilization. COVID-19, coronavirus disease 2019; ED, Emergency Department; ECG, electrocardiogram; CXR, chest X-ray.
See this image and copyright information in PMC

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