Background: Chest pain is a common complaint in the pediatric ED, but a primary cardiac cause is rare. ECG is frequently utilized to identify cardiac causes of chest pain, but ECG abnormalities do not always correlate with a cardiac etiology. The primary aim of this study is to investigate the occurrence of significant abnormal ECG findings in pediatric patients with chest pain and identify any historical or clinical predictors associated with the abnormal findings.
Methods: This was a retrospective chart review of children 5 to 18 years of age who presented to a tertiary care pediatric ED between January 1, 2016 and December 31, 2016 and underwent an ECG for documented chest pain. Charts were reviewed for demographic features, ECG findings as documented by a pediatric electrophysiologist, presenting history, personal past and family history, and exam findings. Significance of ECG findings were determined a priori based on local pediatric expert consensus and literature review.
Results: 640 records were initially reviewed, of which 512 met inclusion criteria. Children with a previous significant cardiovascular disease history, recent blunt chest trauma or those who did not meet the age range were excluded from the study. A total of 43 significant findings were observed from 41 different ECGs, representing 8% (95%CI 5.7-10.4) of the total reviewed ECGs. No statistically significant relationships were found between the demographic variables having an abnormal finding. Three categories (ST segment changes, extreme axis deviation and prolonged QTc intervals) accounted for 56% of the abnormal findings. Historical and clinical predictors associated with clinically significant abnormal ECG findings include personal history of rheumatologic disease, viral prodrome on presentation and respiratory distress. No subjects required admission for acute cardiology intervention. Five subjects (1%) were found to have clinically significant cardiac pathology on follow-up (2 with WPW, 1 with pericarditis, 1 with high degree AV block and 1 with aberrant circumflex artery origin).
Conclusion: Significant abnormal ECG findings are rare in the evaluation of pediatric chest pain, and even when present, do not always correlate to a cardiac cause of chest pain. Education about selective ECG use can improve practice variation and decrease resource utilization for pediatric chest pain.