11 Sep Pediatric Cardiology Chest Pain Guideline Validation
David R. Fulton, M.D.
Associate Cardiologist-in-Chief for Administration
Tommy Kaplan Chair in Cardiovascular Studies
Chief, Cardiology Outpatient Services
Department of Cardiology
Children’s Hospital Boston
Boston, MA 02115
MedicalResearch.com: What are the main findings of this study?
Dr. Fulton: The main findings of this study demonstrated that using a quality improvement methodology (SCAMPs), a diverse population of children and adolescents with chest pain could be managed with relative uniformity and cost effectiveness in a multi-center collaborative. Only 2 patients of the 1016 children who formed the basis for this review were shown to have a cardiac etiology. The clinicians were able to screen and reach a diagnostic conclusion in a large segment of this population using history, physical examination and ECG.
MedicalResearch.com: Where any of the findings unexpected?
Dr. Fulton: The SCAMP recommended minimal testing other than the use of echocardiography when prompted by abnormalities in the above triad, but clinicians were encouraged to diverge from the guideline as long as reasons for their decisions were stated. Though not necessarily expected, the frequency of testing was minimally different between the regional groups and the large academic medical center. Simultaneously, the frequency of exercise testing and Holter monitor recordings were vastly reduced. Since the approach was adapted widely among groups of providers with virtually similar conclusions, the algorithm was clearly scalable along the continuum from small private practice cardiologists to a that of a large academic center.
MedicalResearch.com: What should patients and clinicians take away from this report?
Dr. Fulton: This report should suggest to primary care providers as well as pediatric cardiologists that most children with chest pain do not have a cardiac etiology and can be managed with a thoughtful approach to basic clinical assessment reducing the need for unnecessary resource utilization. Patients should feel reassured that life-threatening cardiac disease in children who present with chest pain is rare and management with a minimal amount of testing represents rational clinical care.
MedicalResearch.com: What further research do you suggest as a result of your study?
Dr. Fulton: SCAMPs proved to be a very useful tool for chest pain management and holds promise for extension to many areas of clinical medicine including both inpatient and outpatient health care delivery. We are in the process of expanding and testing this model in a variety of symptoms, clinical conditions, disease states and process workflows.
Gerald H. Angoff, David A. Kane, Niels Giddins, Yvonne M. Paris, Adrian M. Moran, Victoria Tantengco, Kathleen M. Rotondo, Lucy Arnold, Olga H. Toro-Salazar, Naomi S. Gauthier, Estella Kanevsky, Ashley Renaud, Robert L. Geggel, David W. Brown, and David R. Fulton
Pediatrics peds.2013-0086; published ahead of print September 9, 2013, doi:10.1542/peds.2013-0086