Resident Physician Brooklyn Hospital Center The Brooklyn Hospital Center Brooklyn, New York, United States
Background: Chest pain in children is a common presenting complaint to the emergency department (ED) and frequently attributed to minor non-life-threatening illnesses. Most experts recommend no or minimal work up, with additional work up based on elements of the history and physical exam. We noticed that since COVID-19 pandemic, increased number of patients with acute chest pain were getting imaging and lab evaluation. We hypothesized that the COVID-19 pandemic is shifting the paradigm of chest pain evaluation in the pediatric ED towards more extensive work up.
Objective: The primary objective of this study is to determine if there is increased testing for pediatric patients presenting with chest pain to the ED since the COVID-19 pandemic. Secondary objective is to determine the types of tests and abnormalities detected and association with hospitalization.
Design/Methods: Retrospective study with chart review of all children < 21 years old that presented with the primary complaint of chest pain to the ED between the months of January and July during the years 2019 (historical control group) and 2020 (post COVID-19 pandemic group).
Results: Of the 180 patients evaluated for chest pain, 32 excluded as chest pain attributed to physician-diagnosed asthma and the remaining 148 patients are the subjects of this study. No significant differences identified in the demographics, symptoms of fever or cough, between the two groups. Significantly, more children had tachycardia and tachypnea (see table). Laboratory workup performed on 3% of the patients in 2019 compared to 23% in 2020 (p value < 0.001). There was a statistically significant increase in the lab evaluation of cardiac enzymes, D-dimers and inflammatory biomarkers in the 2020 group. The overall number of abnormalities detected was 7% (n=5/72) in 2019 compared to 41% (n=8/44) in 2020 (p=0001). COVID PCR was performed in 10 patients (7%) of whom two patients were positive. There was significant association of hospitalizations with the post-pandemic (n=5, 8.9%) group compared to the 2019 (1.1%; p=<0.06) group. COVID -19 related hospitalizations occurred in 3 patients (COVID pneumonia =2, HbSC disease/pulmonary embolism (n=1). Conclusion(s): There is an emerging trend to perform imaging and lab work up since the onset of COVID pandemic for patients presenting with acute chest pain to the ED. There appears to be a need to update guidelines towards appropriate diagnostic work up of acute chest pain in children post the COVID-19 pandemic.
Authors/Institutions: Rucha Patki, The Brooklyn Hospital Center, Brooklyn, New York, United States; Majo Joseph, The Brooklyn Hospital Center, Brooklyn, New York, United States; Noah P. Kondamudi, The Brooklyn Hospital Center, Brooklyn, New York, United States