552 - Difference in management approach of chest pain in emergency medicine physicians vs. pediatric trained emergency medicine physicians

Publication Number: 552.4548

Priya M. Thanneeru, The Brooklyn Hospital Center, Brooklyn, NY, United States; Amrita Gujar, Brooklyn Hospital Center, Brooklyn, NY, United States; Majo Joseph, Brooklyn Hospital Center, Brooklyn, NY, United States; Noah P. Kondamudi, THE BROOKLYN HOSPITAL CENTER, Brooklyn, NY, United States

Background:

Introduction: Chest pain frequently presents as a common concern among children in the emergency department (ED). The presence of acute chest pain in adults prompts concern for coronary artery disease and myocardial infarction, necessitating swift cardiac assessment to avert adverse outcomes unlike the benign outcomes in pediatric patients. Due to vast outcome differences, emergency medicine physicians managing pediatric patients tend to order complementary diagnostic tests in the treatment of chest pain compared to the pediatric trained emergency medicine physicians. There is existing literature that common diagnostic procedures cause significant distress especially in children. Hence, it is important to identify areas of diagnostic procedures that are avoidable when not needed.

Objective: This study aims to understand the difference in management approach of chest pain in pediatric patients by the emergency medicine(EM) physicians and pediatric trained emergency medicine physicians. It assesses the difference in workup ordered by these two attending groups in the absence of existing causes of chest pain.

Design/Methods: We identified pediatric patients less than 21 years of age presenting with chief complaints of chest pain to the pediatric ED in the years 2022-2023. We reviewed the electronic health records of patients extensively to understand the underlying conditions, workup ordered by the managing physician, and discharge diagnosis of the respective patients. We categorized the sample based on the managing EM physicians and pediatric trained EM physicians and the labs ordered. Using chi-square analysis, we analyzed the significance in the difference of management approach.

Results: We identified 317 pediatric patients presenting with chest pain to the Emergency department. Of them, 45.5% were ≤ 12 years of age and 54.5% were > 12 years of age. From the total sample, 61.5% were managed by EM physicians and 38.5% were managed by pediatric trained EM physicians. There was equal distribution of males and females. There was significant association (p-value=0.003) of chest x-ray use and performance of lab tests by EM physicians compared to pediatric trained EM physicians in patients with benign outcomes.

Conclusion(s): In evaluating chest pain in ED, EM physicians perform more x-rays and lab tests compared to pediatric trained EM physicians. A well-conceived evidence based guideline addressing management of acute chest pain in children presenting to the ED can help diminish this variation in practice and serve to improve the quality of care for children when testing can be avoided.

Chi- square analysis to assess the workup ordered by EM physicians vs. Pediatric trained EM physicians managing pediatric patients with chest pain presentation to the Emergency Department (ED)