Etiology and Outcomes of Pediatric Chest Pain in the ED: A Systematic Review.

Chest pain is a frequent complaint among children presenting to EDs, often raising concerns about underlying cardiac disease. This systematic review aimed to synthesize available evidence on the etiology, clinical outcomes, and prognosis of pediatric chest pain in ED settings. A systematic search of PubMed, BMJ Journals, Scopus, IEEE Xplore, and Web of Science was conducted to identify relevant studies. Studies reporting original data on children (<19 years) presenting with chest pain in ED settings were included. Study quality was assessed using the Newcastle-Ottawa Scale. Due to heterogeneity among the studies, a narrative synthesis of the findings was performed. Six retrospective studies comprising 14,871 patients from five countries met the inclusion criteria. Idiopathic chest pain was the most common etiology, accounting for 24.4%-45.4% of cases. Musculoskeletal (4.7%-33.0%), respiratory (2.9%-17.7%), and psychogenic causes (6.0%-21.6%) were also frequently reported. Cardiac etiology was rare in unselected populations (0.9%-1.5%), although a higher prevalence (7.1%) was observed in ambulance-attended cohorts. Hospitalization rates ranged from 0.3% to 7.2%, and cardiac interventions were required in fewer than 0.3% of patients. Mortality was reported to be below 0.2% across all studies. Five studies were rated as good quality, while one study was rated as fair quality. Pediatric chest pain in ED settings is predominantly benign, with idiopathic causes being the most common and cardiac pathology being rare. Mortality is exceptionally low, supporting reassurance and targeted evaluation rather than routine extensive diagnostic testing.