Emergency Department Admissions of Children with Chest Pain before and during COVID-19 Pandemic

Abstract

Objectives: We compared the number of accesses, causes, and instrumental evaluations of chest pain in children between the pre-COVID-19 era and the COVID-19 period and analyzed the assessment performed in children with chest pain, highlighting unnecessary examinations. Methods: We enrolled children with chest pain admitted to our emergency department between January 2019 and May 2021. We collected demographic and clinical characteristics and findings on physical examinations, laboratory tests, and diagnostic evaluations. Then, we compared the number of accesses, causes, and instrumental assessments of chest pain between the pre-COVID-19 era and the COVID-19 era. Results: A total of 111 patients enrolled (mean age: 119.8 ± 40.48 months; 62 males). The most frequent cause of chest pain was idiopathic (58.55%); we showed a cardiac origin in 4.5% of the cases. Troponin determination was performed in 107 patients, and the value was high only in one case; chest X-rays in 55 cases and echocardiograms in 25 cases showed pathological findings, respectively, in 10 and 5 cases. Chest pain accesses increased during the COVID-19 era (p < 0.0001), with no differences in the causes of chest pain between the two periods. Conclusions: The increase in accesses for chest pain during the COVID-19 pandemic confirms that this symptom generates anxiety among parents. Furthermore, our findings demonstrate that the evaluation of chest pain is still extensive, and new chest pain assessment protocols in the pediatric age group are needed.

Pediatric Chest Pain: A Review of Diagnostic Tools in the Pediatric Emergency Department

“…Psychogenic chest pain is also a common cause among children and adolescents. According to previous studies, it accounts for about 5.1-83.6% of all cases in this group [1,2,9,14,[17][18][19]. Recent studies have found that psychogenic chest pain in children and adolescents may exceed 20.0% [1,14,17,19], with some studies indicating as high as 83.6% [17].…”

“…Chest pain in children and adolescents could be divided into the following etiologies: musculoskeletal, idiopathic, pulmonary, gastrointestinal, psychogenic, cardiac, or miscellaneous causes [ 1 , 2 , 9 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Due to varying classifications of the causes of chest pain in different articles and the lack of uniformity in diagnostic definitions among these articles, the exact proportion of chest pain in children and adolescents varies from study to study.…”

“…Due to varying classifications of the causes of chest pain in different articles and the lack of uniformity in diagnostic definitions among these articles, the exact proportion of chest pain in children and adolescents varies from study to study. However, it is clear that cardiac chest pain is relatively rare in the pediatric population, accounting for 0.6–8.0% [ 1 , 2 , 9 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ].…”

“…Most of the studies found that the causes of chest pain in children and adolescents are predominantly musculoskeletal and/or idiopathic, accounting for 38.7–86.3% [ 1 , 2 , 9 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Chest pain due to musculoskeletal causes can often be diagnosed through medical history and physical examination alone, with limited assistance from additional diagnostic examinations.…”

“…However, chest pain in the pediatric population is generally a benign disease, with the most common cause being musculoskeletal pain, which can be identified simply with detailed history-taking and physical examination [ 1 , 3 , 4 , 7 , 8 ]. Cardiac chest pains in children, on the other hand, are rare, accounting for 0.3–8.0% of all children and adolescents with chest pain ( Table 1 ) [ 1 , 2 , 4 , 7 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ]. Several studies have noted that many examinations performed in the emergency department have limited diagnostic value [ 1 , 2 , 4 , 9 , 20 , 21 ].…”