Needles in Hay: Chest Pain as the Presenting Symptom in Children with Serious Underlying Cardiac Pathology

Kane, David; Fulton, David R.; Saleeb, Susan F.; Zhou, Jing; Lock, James E.; Geggel, Robert L.

doi:10.1111/j.1747-0803.2010.00436.x

Cited by 63 publications

(80 citation statements)

References 13 publications

(36 reference statements)

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“…By previous reports, most pediatric patients with chest pain caused by myocarditis, pericarditis, pulmonary embolism, or cardiomyopathy present to the emergency department. 1,3,14 The outpatient cardiology department is the setting where rare congenital coronary anomalies are typically identified. Specifying echocardiography as the diagnostic test of choice is based on its ability to identify coronary anomalies.…”

Section: Discussionmentioning

confidence: 99%

“…Fever (oral .38.4°C) was the indication for a chest x-ray. Exercise stress testing, ambulatory ECG (Holter) monitoring, and event recorder monitoring were not included as appropriate tests in the algorithm based on previous study, 1,3,17,18 but were tracked as part of the adherence and outcome analysis.…”

Section: Data Collection and Scamp Algorithmmentioning

confidence: 99%

“…The evaluation is often resource intensive and costly despite the low incidence of cardiac pathology ranging from 0% to 5%. [1][2][3][4][5][6][7][8][9][10][11][12][13] This low incidence has been documented in the emergency setting as well as ambulatory care. 14 Many previous reports on pediatric chest pain have been observational and lack guideline recommendation.…”

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confidence: 99%

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Regional Implementation of a Pediatric Cardiology Chest Pain Guideline Using SCAMPs Methodology

et al. 2013

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BACKGROUND AND OBJECTIVES: Chest pain is a complaint for which children are frequently evaluated. Cardiac causes are rarely found despite expenditure of considerable time and resources. We describe validation throughout New England of a clinical guideline for cost-effective evaluation of pediatric patients first seen by a cardiologist for chest pain using a unique methodology termed the Standardized Clinical Assessment and Management Plans (SCAMPs). METHODS: A total of 1016 ambulatory patients, ages 7 to 21 years initially seen for chest pain at Boston Children’s Hospital (BCH) or the New England Congenital Cardiology Association (NECCA) practices, were evaluated by using a SCAMPs chest pain guideline. Findings were analyzed for diagnostic elements, patterns of care, and compliance with the guideline. Results from the NECCA practices were compared with those of Boston Children’s Hospital, a regional core academic center. RESULTS: Two patients had chest pain due to a cardiac etiology, 1 with pericarditis and 1 with an anomalous coronary artery origin. Testing performed outside of guideline recommendations demonstrated only incidental findings. Patients returning for persistent symptoms did not have cardiac disease. The pattern of care for the NECCA practices and BCH differed minimally. CONCLUSIONS: By using SCAMPs methodology, we have demonstrated that chest pain in children is rarely caused by heart disease and can be evaluated in the ambulatory setting efficiently and effectively using minimal resources. The methodology can be implemented regionally across a wide range of clinical practice settings and its approach can overcome a number of barriers that often limit clinical practice guideline implementation.

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Section: Discussionmentioning

confidence: 99%

Section: Data Collection and Scamp Algorithmmentioning

confidence: 99%

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Regional Implementation of a Pediatric Cardiology Chest Pain Guideline Using SCAMPs Methodology

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“…The low incidence of identified cardiac disease, combined with Kane's retrospective analysis demonstrating the effectiveness of identifying life‐threatening cardiac disease using the chest pain clinical pathway,10 emphasize that clinicians are quite effective at identifying those disorders. Hence, when patients return with problematic symptoms, and without a specific feature of the history suggesting serious disease, the focus may be more on effective management of the symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…New England Congenital Cardiology Association (NECCA), an organization of ≈16 academic and community‐based practices representing all 6 New England states, previously successfully implemented a SCAMP on chest pain resulting in a decrease in practice variation and resource utilization 7, 9, 10…”

Section: Introductionmentioning

confidence: 99%

Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology

Paris

Toro‐Salazar

Gauthier

et al. 2016

JAHA

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BackgroundPediatric syncope is common. Cardiac causes are rarely found. We describe and assess a pragmatic approach to these patients first seen by a pediatric cardiologist in the New England region, using Standardized Clinical Assessment and Management Plans (SCAMPs).Methods and ResultsAmbulatory patients aged 7 to 21 years initially seen for syncope at participating New England Congenital Cardiology Association practices over a 2.5‐year period were evaluated using a SCAMP. Findings were iteratively analyzed and the care pathway was revised. The vast majority (85%) of the 1254 patients had typical syncope. A minority had exercise‐related or more problematic symptoms. Guideline‐defined testing identified one patient with cardiac syncope. Syncope Severity Scores correlated well between physician and patient perceived symptoms. Orthostatic vital signs were of limited use. Largely incidental findings were seen in 10% of ECGs and 11% of echocardiograms. The 10% returning for follow‐up, by design, reported more significant symptoms, but did not have newly recognized cardiac disease. Iterative analysis helped refine the approach.Conclusions SCAMP methodology confirmed that the vast majority of children referred to the outpatient pediatric cardiology setting had typical low‐severity neurally mediated syncope that could be effectively evaluated in a single visit using minimal resources. A simple scoring system can help triage patients into treatment categories. Prespecified criteria permitted the effective diagnosis of the single patient with a clear cardiac etiology. Patients with higher syncope scores still have a very low risk of cardiac disease, but may warrant attention.

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Chest Pain in Children: Not Always Benign

Theocharis

Magee

2016

Practical Pediatric Cardiology

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Needles in Hay: Chest Pain as the Presenting Symptom in Children with Serious Underlying Cardiac Pathology

Cited by 63 publications

References 13 publications

Regional Implementation of a Pediatric Cardiology Chest Pain Guideline Using SCAMPs Methodology

Regional Implementation of a Pediatric Cardiology Chest Pain Guideline Using SCAMPs Methodology

Regional Implementation of a Pediatric Cardiology Syncope Algorithm Using Standardized Clinical Assessment and Management Plans (SCAMPS) Methodology

Chest Pain in Children: Not Always Benign

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