O1001: Evaluation of Clinical Resource Utilization in Pediatric Patients Presenting with Chest Pain in an Ambulatory Care Setting versus Emergency Department

Background: Chest pain is a common presenting complaint that evokes anxiety and distress amongst patients, families, and caregivers. The etiology for chest pain in a pediatric patient is either musculoskeletal, pulmonary, gastrointestinal, cardiac or psychogenic. Most cases are related to benign conditions with numerous publications discovering only a minority originate from cardiac origin (~1%). Limited data are published comparing the different diagnostic approaches in evaluating patients presenting for an emergency department (ED) visit versus an ambulatory clinic (AC) visit. Our study seeks to compare these two clinical settings and assess if there is a statistical difference in the number of studies performed and the etiology amongst the two settings.

Methods: A retrospective cross-sectional study of patients ages 3 – < 18 years evaluated in either an ED or an AC between January 1 to December 31, 2021 with concerns of chest pain. We included the ICD-10 codes for chest pain: R07.1, R07.89, R07.9. Data collected included age, gender, description of history of presenting illness, laboratory studies, diagnostic testing, imaging studies, final disposition, and final diagnosis. Comparison between groups was performed by t-test for continuous variables and Chi-square, Fischer exact and one-way analysis of variance (ANOVA) tests for discrete variable.

Results: A total of 607 charts were reviewed with 106 excluded due to missing variables. Patients included were 286 ED and 215 AC. There was no significant difference in age between ED (12.81 ±3.6) and AC (12.72 ±3.5); t=0.28, p = 0.78. There was a significant increase in laboratory tests performed in the ED compared to the AC χ2 = 153.42, p < 0.001. Breakdown of specific laboratory tests obtained showed a statistically significant higher utilization of CMP, BMP, Magnesium, CBC, Troponin, and BNP in the ED (p < 0.001). No difference was seen obtaining CK, Procalcitonin, ESR, CRP, and TSH. Furthermore, there was increased utilization of Chest Radiographs in the ED χ2 = 273.01 and ECG χ2 = 47.32, p < 0.001. The CT chest ordering is significantly higher in the ED than the AC (Fisher exact P< 0.001). In the AC, there were more Holters and Stress tests ordered (Fisher exact P< 0.001). Ultimately, no difference was found in the final types of diagnoses between the ED and AC (ANOVA: F= 0.3092; p = 0.59). Only 1% of patients had a cardiac origin to chest pain (Figure 1).

Conclusion: Our data show there is a statistically significant higher utilization of clinical diagnostic tests for the evaluation of pediatric patients who present to an emergency department with chest pain in comparison to the evaluation conducted in an ambulatory care clinic. There is no difference in final diagnosis between the ED and AC.