Chest Pain Clinical Pathway — Emergency Department
Chief Complaint of Chest Pain
Population
Use this pathway to guide the evaluation of the chief complaint of chest pain in healthy children without known cardiac disease.
Exclusions
- Known cardiac history or prior cardiac surgery
- Sickle Cell Disease
- Kawasaki Disease
- Asthma
Background Information
Chest pain is a common chief complaint in pediatric outpatient and emergency department visits (0.6-5%) and is the second most common reason for referral to a pediatric cardiologist. Parents and children 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 in only 2% of children.
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.