Pediatric Chest Pain Management and Diagnostic Evaluation
Summary
Children commonly present with chest pain to emergency departments and outpatient clinics, yet serious cardiac pathology is rare. A multidisciplinary diagnostic approach centres on detailed history-taking and physical examination, stratifying risk according to symptom characteristics, age and family history. Initial evaluation aims to distinguish benign causes—principally musculoskeletal, such as costochondritis—from potentially life-threatening aetiologies including myocarditis, pericarditis, anomalous coronary arteries and arrhythmias. Standardised clinical algorithms incorporate targeted use of investigations—electrocardiography, chest radiography, cardiac biomarkers and echocardiography—to optimise resource utilisation and reduce unnecessary testing. Emerging protocols emphasise selective rather than routine application of advanced imaging or laboratory assays. Management is tailored to the underlying diagnosis: reassurance and conservative measures for non-cardiac chest pain; anti-inflammatory agents for pericarditis; referral to specialist centres for congenital or inflammatory cardiac conditions. Global initiatives now seek to harmonise guidelines and implement quality improvement frameworks to standardise assessment and minimise practice variation while ensuring prompt identification of serious disease.
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Pediatric Chest Pain Management and Diagnostic Evaluation publication trend
The graph below shows the total number of articles in pediatric chest pain management and diagnostic evaluation across all publications each year (not limited to Nature Index journals).
Technical terms
Electrocardiogram (ECG): A non-invasive recording of the heart’s electrical activity used to detect arrhythmias and structural abnormalities.
Echocardiography: Ultrasound imaging of cardiac structures and function, employed to identify congenital defects, myocarditis and pericardial disease.
C-reactive protein (CRP): An acute-phase biomarker measured in blood tests, indicative of systemic inflammation.
Troponin: Cardiac muscle proteins released into the bloodstream during myocyte injury, used as markers of myocardial damage.
Multisystem inflammatory syndrome in children (MIS-C): A post-infectious inflammatory condition associated with SARS-CoV-2 that can present with chest pain and cardiac dysfunction.
References
- Pediatric Chest Pain: A Review of Diagnostic Tools in the Pediatric Emergency Department. Diagnostics (2024).
- Resource Utilization Reduction for Evaluation of Chest Pain in Pediatrics Using a Novel Standardized Clinical Assessment and Management Plan (SCAMP). Journal of the American Heart Association (2012).
- Diagnostic testing for chest pain in a pediatric emergency department and rates of cardiac disease before and during the COVID-19 pandemic: a retrospective study. Frontiers in Pediatrics (2024).
- Chest pain in pediatric patients in the emergency department- Presentation, risk factors and outcomes-A systematic review and meta-analysis. PLOS ONE (2024).
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