Management of Pediatric Chest Pain Using a Standardized Assessment and Management Plan

Abstract

Evaluation of pediatric chest pain is often extensive and rarely yields a cardiac etiology. Practice variation and unnecessary resource use remain concerns. Targeted testing can reduce resource use and lead to more cost-effective care.

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

“…This SCAMP shows that the indication for diagnostic studies can be limited and keyed to presenting symptoms, focused history, cardiac physical findings, and ECG abnormalities. Exercise testing and rhythm monitoring, excluded from the algorithm based on previous study, 1,3,17,18 provide no clear diagnostic benefit. Chest x-ray in the absence of febrile illness was not beneficial.…”

“…[15][16][17] This algorithm is designed to identify cardiac causes of chest pain while effectively using resources in the outpatient cardiology clinic setting. The algorithm was used to analyze the combined patient population and to compare outcomes of those seen at BCH and NECCA sites.…”

“…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.…”

“…We have designed and reported on a quality improvement tool termed Standardized Clinical Assessment and Management Plans (SCAMPs), which guides care of patients with a single presenting symptom or condition according to an algorithm designed by clinicians that improves outcomes, narrows practice variability, and reduces unnecessary testing. [15][16][17] Although sharing some similarities to clinical practice guidelines, SCAMPs differ by mandating data acquisition, analyzing the data on a recurring basis, and altering the SCAMP based on the analysis. Providers are permitted to divert from the pathways, although they are requested to explain the reasons for the action taken potentially offering new insight into the management of the clinical problem.…”

“…Our previous experience has demonstrated a decrease in practice variation and a marked reduction in unnecessary resource utilization compared with historic controls. 17 The New England Congenital Cardiology Association (NECCA) is an organization of 16 academic and community-based practices with 115 member physicians representing all 6 New England states. NECCAwasformed in 2009 witha mission to improve continuously the quality, safety, effectiveness, availability, and cost of care for children and adults with known or suspected congenital or acquired heart disease of childhood.…”