Department of Cardiology, Children's Hospital Boston, Boston, MA 02115, USA.
Pediatrics. 2011 Aug;128(2):239-45. doi: 10.1542/peds.2011-0141. Epub 2011 Jul 11.
Chest pain is a common reason for referral to pediatric cardiologists and often leads to an extensive cardiac evaluation. The objective of this study is to describe current management practices in the assessment of pediatric chest pain and to determine whether a standardized care approach could reduce unnecessary testing.
We reviewed all patients, aged 7 to 21 years, presenting to our outpatient pediatric cardiology division in 2009 for evaluation of chest pain. Demographics, clinical characteristics, patient outcomes, and resource use were analyzed.
Testing included electrocardiography (ECG) in all 406 patients, echocardiography in 175 (43%), exercise stress testing in 114 (28%), event monitoring in 40 (10%), and Holter monitoring in 30 (7%). A total of 44 (11%) patients had a clinically significant medical or family history, an abnormal cardiac examination, and/or an abnormal ECG. Exertional chest pain was present in 150 (37%) patients. In the entire cohort, a cardiac etiology for chest pain was found in only 5 of 406 (1.2%) patients. Two patients had pericarditits, and 3 had arrhythmias. We developed an algorithm using pertinent history, physical examination, and ECG findings to suggest when additional testing is indicated. Applying the algorithm to this cohort could lead to an ∼20% reduction in echocardiogram and outpatient rhythm monitor use and elimination of exercise stress testing while still capturing all cardiac diagnoses.
Evaluation of pediatric chest pain is often extensive and rarely yields a cardiac etiology. Practice variation and unnecessary resource use remain concerns. Targeted testing can reduce resource use and lead to more cost-effective care.
胸痛是小儿心脏病专家就诊的常见原因，常需要进行广泛的心脏评估。本研究旨在描述目前儿科胸痛评估的管理实践，并确定标准化护理方法是否可以减少不必要的检查。
我们回顾了 2009 年在我们的儿科心脏病门诊就诊的所有年龄在 7 至 21 岁的胸痛患者。分析了患者的人口统计学、临床特征、患者结局和资源使用情况。
406 名患者均行心电图（ECG）检查，175 名（43%）行超声心动图检查，114 名（28%）行运动负荷试验检查，40 名（10%）行事件监测检查，30 名（7%）行动态心电图监测检查。共有 44 名（11%）患者有临床意义的医学或家族史、异常的心脏检查和/或异常的心电图。150 名（37%）患者有运动性胸痛。在整个队列中，仅 406 名患者中的 5 名（1.2%）患者发现胸痛的心脏病因。2 名患者为心包炎，3 名患者为心律失常。我们使用相关的病史、体格检查和心电图结果制定了一个算法，以提示何时需要进行额外的检查。将该算法应用于该队列可能会导致超声心动图和门诊节律监测使用减少约 20%，同时消除运动负荷试验，而仍能捕捉到所有心脏诊断。
儿科胸痛的评估通常广泛，但很少发现心脏病因。实践差异和不必要的资源使用仍然是关注点。有针对性的检查可以减少资源的使用，从而实现更具成本效益的护理。
