| خلاصه مقاله | Chest pain is an alarming complaint in children, leading an often frightened
and concerned family to a pediatrician or emergency room and commonly to a
subsequent referal to a pediatric cardiologist. Because of the well-known association of chest pain with significant cardiovascular disease and sudden death in
adult patients, medical personnel commonly share heightened concerns over
pediatric patients presenting with chest pain.
Although the differential diagnosis of chest pain is exhaustive, chest pain in children is least likely to be cardiac in origin. Organ systems responsible for causing chest pain in children include:Idiopathic (12%-85%), Musculoskeletal (15%-31%),Pulmonary (12%-21%),Other (4%-21%),Psychiatric (5%-17%)
Gastrointestinal (4'/0-7%),Cardiac( 3%4%)
Furthermore, chest pain in the pediatric population is rarely associated with
life-threatening disease; however, when present, prompt recognition, diagnostic
evaluation, and intervention are necessary to prevent an adverse outcome. This
article presents a comprehensive list of differential diagnostic possibilities of
chest pain in pediatric patients, discusses the common causes in further detail,
and outlines a rational diagnostic evaluation and treatment plan.
Chest pain, a common complaint of pediatric patients, is often idiopathic in
etiology and commonly chronic in nature. In one study,67 chest pain accounted
for 6 in 1000 visits to an pediatric emergency room. In addition, chest pain is the second most common reason for referral to pediatric cardiologist.
Chest pain is found equally in male and female patients, with an average age of presentation of 13 years. Chest pain in the pediatric population is most commonly idiopathic in etiology, representing 23% to 45% of all cases.
Children fewer than 12 years of age are more likely to have a cardiorespiratory
cause of their chest pain compared with children more than 12 years of age,
who are more likely to have a psychogenic cause, patients diagnosed with psychogenic chest pain or costochondritis are more likely to be female.Chest pain is a chronic condition in the pediatric population, with persistent symptoms in 45% to 69% of patient and 19% of patients having symptoms lasting for more than 3 years .The corollary, of course, is that in 81% of patients with persistent symptoms, the chest pain resolves with time.
Clinically reassuring is that none of the patients followed over 3 years developed
any severe disease process.Because of the chronic nature and often unconfirmed
cause of chest pain, pediatricians must develop a trusting, working relationship with these children and their families and be prepared to work jointly over time in diagnosing and treating patients with this very common and predominantly benign complaint. |