165: Paediatric Chest Pain in the Emergency Department
Notice bibliographique
Résumé
Chest pain is a frequent chief complaint of paediatric patients presenting to the emergency department (ED). Despite the low risk of a cardiac cause in the paediatric population, chest pain is a worrisome presentation for patients and their families, and sometimes serious underlying pathology can occur. There is no evidence based diagnostic approach, and this results in significant practice variation often with extensive investigations, both in the ED and in follow-up. To establish poor predictive value and over-use of diagnostic testing in pediatric patients presenting with chest pain. After REB approval, a chart review was conducted of all patients presenting to an urban paediatric tertiary care ED with the chief complaint of chest pain over a three year period. Charts were analyzed for sex, age at presentation, associated symptoms, past cardiac history, investigations in the ED, discharge diagnosis, and outpatient echocardiogram and Holter monitor findings. Of the 473 visits, 50 were repeat visits. The mean age at visit was 12.1 years, and mean duration of pain was 53.4 minutes. 16.9% (n=80) of patients reported past cardiac-related medical history. 64.9% (n=307) of patients received chest x-ray, but only 2.9% (n=9) had an abnormal finding. Electrocardiogram was done in 75.7% (n=358) of the patients, and 23.7% (n=85) of the results were abnormal. Troponin was done in 9.5% (n=45) of the cases, with only one abnormal result unrelated to cardiac etiology. 96.0% of patients (n=454) were discharged, and 4% (n=19) were admitted to hospital. Most causes were idiopathic (n=282, 59.6%), followed by musculoskeletal causes (n=145, 30.7%). Within six months following discharge, 75 (15.9%) patients received echocardiogram, 45 (60%) of whom had no reported cardiac history or previous investigations, and 25 had normal ECG in the ED. The echocardiograms yielded only two cases of newly diagnosed mitral valve prolapse, and one case of small patent ductus arteriosus. 50 patients (10.6%) received Holter monitoring within six months following discharge, 20 of whom had no previous cardiac history, and had normal ECGs in the ED, and the arrhythmias found on Holter monitor correlated poorly with the presenting symptoms. This is the largest paediatric review of chest pain in Canada in published literature. Chest pain in the paediatric population are rarely due to cardiac causes, but most patients still receive unnecessary investigations in the ED, and in their follow-up visits. An evidence based diagnostic algorithm would be useful to improve resource utilization in children presenting with chest pain.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,020 | 0,004 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».