ED Pathway for the Evaluation/Treatment of Chest Pain in Children without Known Cardiac Disease

Chief Complaint of Chest Pain

Population

Use this pathway to guide the evaluation of the chief complaint of chest pain in healthy patients without known cardiac disease.

Exclusions:

Background Information

Chest pain is a common chief complaint in pediatric outpatient and emergency department visits (0.6-5%) and is the 2nd most common reason for referral to a pediatric cardiologist. Parents and patients are concerned about the possibility of heart disease which could be very serious and/or life-threatening. However, cardiac etiologies are exceedingly rare in healthy children and adolescents, < 1% of those seen in the general outpatient setting or emergency department. In fact, of those referred to a Pediatric Cardiologist, a cardiac etiology will be found on only 2% of patients.

Some other interesting facts:

A thorough history and physical examination will elucidate the etiology or generate a short, specific differential diagnosis. Thus routine laboratory and radiographic testing are not routinely indicated.