{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T11:57:07Z","timestamp":1774007827819,"version":"3.50.1"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2022,5,1]],"date-time":"2022-05-01T00:00:00Z","timestamp":1651363200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>Chest pain in children and adolescents is a common complaint in the emergency department (ED), being mostly benign. A thorough patient history and physical examination should be enough in most cases for its proper management. Regarding non-cardiac chest pain, anxiety plays an important role.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Retrospective analysis of all admissions in a pediatric ED of a Portuguese third-level hospital with a chief complaint of chest pain between January and December 2018. Chi-square test was used to compare different etiologies, considering a significance level of 5%.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>A total of 798 visits were included: 53.6% girls, 80.8% adolescents (mean age: 13years old). According to the Pediatric Canadian Triage and Acuity Scale, 77.7% was prioritized as level IV: less urgent; 65.3% reported associated symptoms including dyspnea (31.8%), cough (18.2%), and palpitations (16.1%). In physical examination, 45.5% had alterations: 62.8% with chest wall tenderness. Further investigation was done in 84% of patients: 62.4% electrocardiograms (altered in 14.7%), 52.6% chest radiographies (altered in 17.1%) and 8.9% cardiac biomarkers (altered in 12.7%). The 3 main causes of chest pain were musculoskeletal (33%), idiopathic (24.4%) and psychogenic (21.6%), with 1.1% of cardiac etiology. Less than 3% needed hospital admission and 18.9% were oriented to an outpatient consultation. 7.1% readmissions reported. When compared to other causes as a group, psychogenic chest pain presented a statistically significant association with female sex, adolescence, psychiatric antecedents, previous stressful event, and normal physical examination. Of these, &lt;30% were oriented to a pedopsychiatry\/psychology consultation.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Opposing to the low priority level in triage, benign diagnosis found, and low hospital admissions, there was a high percentage of complementary diagnostic tests performed with few altered results. In psychogenic chest pain there was a low postdischarge referral. The authors highlight the importance of clinical algorithms to reduce unnecessary tests performed and readmissions and improve orientation and follow-up, particularly in psychogenic etiology.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/j.pbj.0000000000000150","type":"journal-article","created":{"date-parts":[[2022,6,27]],"date-time":"2022-06-27T14:00:08Z","timestamp":1656338408000},"page":"e150","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":11,"title":["Chest pain in a pediatric emergency department: clinical assessment and management reality in a third-level Portuguese hospital"],"prefix":"10.1097","volume":"7","author":[{"given":"Rita","family":"Pissarra","sequence":"first","affiliation":[{"name":"Pediatrics Department,"}]},{"given":"Marisa","family":"Pereira","sequence":"additional","affiliation":[{"name":"Pediatrics Department,"}]},{"given":"Rita","family":"Amorim","sequence":"additional","affiliation":[{"name":"Pediatrics Department,"}]},{"given":"B\u00e1rbara Pereira","family":"Neto","sequence":"additional","affiliation":[{"name":"Pediatrics Department,"}]},{"given":"Lara","family":"Louren\u00e7o","sequence":"additional","affiliation":[{"name":"Pediatrics Department,"}]},{"given":"Lu\u00eds Almeida","family":"Santos","sequence":"additional","affiliation":[{"name":"Pediatric Emergency Department, Centro Hospitalar Universit\u00e1rio S\u00e3o Jo\u00e3o, Porto, Portugal."}]}],"member":"276","published-online":{"date-parts":[[2022,5]]},"reference":[{"key":"R1-20241001","first-page":"271","article-title":"Chest pain in pediatrics","volume":"44","year":"2015","journal-title":"Pediatr Ann."},{"key":"R2-20241001","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1016\/j.pcl.2010.09.013","article-title":"Epidemiology and risk factors of pediatric chest pain: a sytematic 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Pediatr."},{"key":"R14-20241001","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1017\/S1481803500010149","article-title":"Revisions to the Canadian Triage and Acuity Scale paediatric guidelines","volume":"10","year":"2008","journal-title":"CJEM."},{"key":"R15-20241001","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1177\/000992280404300304","article-title":"Chest pain in pediatric patients presenting to an emergency department or to a cardiac clinic","volume":"43","year":"2004","journal-title":"Clin Pediatr."},{"key":"R16-20241001","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1016\/j.ajem.2010.01.011","article-title":"Cardiac disease in pediatric patients presenting to a pediatric ED with chest pain","volume":"29","year":"2011","journal-title":"Am J Emerg Med."},{"key":"R17-20241001","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1097\/PEC.0000000000000861","article-title":"Implementation of a clinical pathway for chest pain in a pediatric 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