Pediatric chest pain in the emergency department: a narrative review and a practical diagnostic approach
Abstract
Chest pain in children is a common presentation in the emergency department (ED) and often generates significant parental concern [1, 2]. Although most cases are benign - most frequently musculoskeletal or gastrointestinal in origin - some presentations require prompt recognition of potentially serious conditions [3, 4]. We propose a multidisciplinary flowchart specifically designed for pediatric ED triage that integrates cardiological, respiratory, gastrointestinal, hematologic, poisoning and psychogenic considerations. Unlike existing pathways, this flowchart emphasizes rapid assessment, structured decision-making, and practical guidance for emergency clinicians, without replacing specialist consultation [5, 6]. We conducted a narrative review using a structured methodology, searching PubMed, Scopus, and CINAHL for studies published in English between 2015 and 2025, focusing on pediatric patients (≤ 18 years) presenting with chest pain [2, 3, 7]. Relevant articles were screened, summarized, and integrated with clinical experience to develop a structured flowchart based on expert opinion [4, 5]. Causes of pediatric chest pain were categorized as cardiovascular (29%), musculoskeletal (13%), respiratory (25%), oncohematologic (13%), gastrointestinal (6%), poisoning and psychogenic (remaining cases) [1, 8, 9]. The flowchart outlines key steps for clinical assessment, diagnostic workup, and referral, including pain scoring, electrocardiography, imaging, and laboratory testing [6, 7]. It is explicitly labeled as expert opinion–based and highlights areas requiring local adaptation [5]. A step-by-step guide tailored for ED implementation is provided. Although chest pain in children is usually benign, careful evaluation is essential to identify potentially serious conditions. The proposed ED flowchart offers a structured, multidisciplinary, and ED-specific approach, supporting triage and early decision-making [1, 3]. Limitations include the need for local adaptation and the lack of formal validation. Early recognition of red flags and appropriate triage may improve patient outcomes [6, 7].