Clinical features of adolescents who visited the emergency department with chest discomfort: the importance of recognizing underlying medical conditions
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Purpose: We aimed to evaluate the clinical features of adolescents who visit emergency departments (EDs) with chest discomfort, and analyze the implications of underlying medical conditions for the development of cardiogenic chest discomfort. Methods: We reviewed the medical records of adolescents (13-18 years) with chest discomfort who visited a tertiary hospital ED in Seoul, Korea from 2014 through 2018. Sex, age, duration and character of the discomfort, symptoms and signs, ED length of stay, abnormal findings of vital signs, chest radiograph, electrocardiogram, and elevated concentrations of cardiac enzymes were reviewed. Final diagnosis was based on cardiac evaluations within 1 year after the index visit. Underlying medical conditions were defined as visits to the cardiology, pulmonology or hematology-oncology clinics at least twice in the preceding year. Initial suspicious clinical findings were defined as palpitation, syncope or high blood pressure. Logistic regression was used to identify predictors for cardiac etiology. Results: Of the 231 patients, 43 (18.6%) and 69 (29.9%) had underlying medical conditions and initial suspicious clinical findings, respectively. The predictors for cardiac etiology were underlying medical conditions (odds ratio, 4.28; 95% confidence interval, 1.09-16.73), initial suspicious clinical findings (4.77; 1.36-16.77), abnormal electrocardiogram (11.54; 3.22- 41.32), and elevated concentration of troponin I (66.52; 5.37-823.55). The patients with cardiogenic chest discomfort had a longer median ED length of stay (281.0 minutes [interquartile range, 215.5-369.0] vs. 199.5 [132.8-298.0]; P = 0.004) and a higher hospitalization rate (48.3% vs. 13.4%; P < 0.001) than those with non-cardiogenic chest discomfort. Conclusion: It may be necessary to recognize underlying medical conditions and initial suspicious clinical findings in EDs prior to cardiac evaluation in adolescents with chest discomfort.
Abstract
Purpose: We aimed to evaluate the clinical features of adolescents who visit emergency departments (EDs) with chest discomfort, and analyze the implications of underlying medical conditions for the development of cardiogenic chest discomfort. Methods: We reviewed the medical records of adolescents (13-18 years) with chest discomfort who visited a tertiary hospital ED in Seoul, Korea from 2014 through 2018. Sex, age, duration and character of the discomfort, symptoms and signs, ED length of stay, abnormal findings of vital signs, chest radiograph, electrocardiogram, and elevated concentrations of cardiac enzymes were reviewed. Final diagnosis was based on cardiac evaluations within 1 year after the index visit. Underlying medical conditions were defined as visits to the cardiology, pulmonology or hematology-oncology clinics at least twice in the preceding year. Initial suspicious clinical findings were defined as palpitation, syncope or high blood pressure. Logistic regression was used to identify predictors for cardiac etiology. Results: Of the 231 patients, 43 (18.6%) and 69 (29.9%) had underlying medical conditions and initial suspicious clinical findings, respectively. The predictors for cardiac etiology were underlying medical conditions (odds ratio, 4.28; 95% confidence interval, 1.09-16.73), initial suspicious clinical findings (4.77; 1.36-16.77), abnormal electrocardiogram (11.54; 3.22- 41.32), and elevated concentration of troponin I (66.52; 5.37-823.55). The patients with cardiogenic chest discomfort had a longer median ED length of stay (281.0 minutes [interquartile range, 215.5-369.0] vs. 199.5 [132.8-298.0]; P = 0.004) and a higher hospitalization rate (48.3% vs. 13.4%; P < 0.001) than those with non-cardiogenic chest discomfort. Conclusion: It may be necessary to recognize underlying medical conditions and initial suspicious clinical findings in EDs prior to cardiac evaluation in adolescents with chest discomfort.
참고문헌 (24)
- Massin MM, "Chest pain in pediatric patients presenting to an emergency department or to a cardiac clinic", Clin Pediatr(Phila), 43, pp.231~238 (2004)
- Massin MM, "Spectrum and frequency of illness presenting to a pediatric emergency department", Acta Clin Belg, 61, pp.161~165 (2006)
- Thull-Freedman J, "Evaluation of chest pain in the pediatric patient", Med Clin North Am, 94, pp.327~347 (2010)
- Geggel RL, "Conditions leading to pediatric cardiology consultation in a tertiary academic hospital", Pediatrics, 114, pp.e409~e417 (2004)
- Selbst SM, "Approach to the child with chest pain", Pediatr Clin North Am, 57, pp.1221~1234 (2010)
- Khairandish Z, "Role of anxiety and depression in adolescents with chest pain referred to a cardiology clinic", Cardiol Young, 27, pp.125~130 (2017)
- Cava JR, "Chest pain in children and adolescents", Pediatr Clin North Am, 51, pp.1553~1568 (2004)
- Saleeb SF, "Effectiveness of screening for life-threatening chest pain in children", Pediatrics, 128, pp.e1062~e1068 (2011)
- 천지혜, "Analysis of clinical characteristics and causes of chest pain in children and adolescents", Clinical and Experimental Pediatrics, 58(11), pp.440~445 (2015), 대한소아청소년과학회
- Sert A, "Clinical characteristics and causes of chest pain in 380 children referred to a paediatric cardiology unit", Cardiol Young, 23, pp.361~367 (2013)
- Patel S, "Management of pediatric chest pain, palpitations, syncope, and murmur presenting to the emergency department", Clin Pediatr Emerg Med, 19, pp.328~339 (2018)
- Friedman KG, "Management of pediatric chest pain using a standardized assessment and management plan", Pediatrics, 128, pp.239~245 (2011)
- Ferguson JL, "Myocardial infarction redefined : the new ACC", ESC definition, based on cardiac troponin, increases the apparent incidence of infarction, 2002, pp.88, 343~347
- Drossner DM, "Cardiac disease in pediatric patients presenting to a pediatric ED with chest pain", Am J Emerg Med, 29, pp.632~638 (2011)
- Yoldas¸ T, "What is the significance of elevated troponin I in children and adolescents? A diagnostic approach", Pediatr Cardiol, 40, pp.1638~1644 (2019)
- Weaver DJ Jr, "Hypertension in children and adolescents", Pediatr Rev, 38, pp.369~382 (2017)
- Bhargava V, "The role of troponin I in the evaluation of chest pain in children and adolescents", EC Pediatr, 3, pp.382~389 (2016)
- Sanchis-Gomar F, "Energy drink overconsumption in adolescents : implications for arrhythmias and other cardiovascular events", Can J Cardiol, 31, pp.572~575 (2015)
- Nowak D, "Analysis of the consumption of caffeinated energy drinks among Polish adolescents", Int J Environ Res Public Health, 12, pp.7910~7921 (2015)
- Acra PE, "The evaluation of adolescent chest pain: a screening ECG or PSC-17?", Curr Opin Pediatr, 29, pp.414~419 (2017)
- Brown JL, "Use of troponin as a screen for chest pain in the pediatric emergency department", Pediatr Cardiol, 33, pp.337~342 (2012)
- Mohan S, "Implementation of a clinical pathway for chest pain in a pediatric emergency department", Pediatr Emerg Care, 34, pp.778~782 (2018)
- Verghese GR, "Resource utilization reduction for evaluation of chest pain in pediatrics using a vovel Standardized Clinical Assessment and Management Plan(SCAMP)", J Am Heart Assoc, 1, pp.jah3~e000349 (2012)
- Karadeniz C, "Does surgically induced right bundle branch block really effect ventricular function in children after ventricular septal defect closure?", Pediatr Cardiol, 36, pp.481~488 (2015)