Pediatric Chest Pain-Low-Probability Referral: A Multi-Institutional Analysis From Standardized Clinical Assessment and Management Plans (SCAMPs®), the Pediatric Health Information Systems Database, and the National Ambulatory Medical Care Survey

Clin Pediatr (Phila). 2017 Nov;56(13):1201-1208. doi: 10.1177/0009922816684605. Epub 2017 Jan 12.


We conducted a study to assess test characteristics of red-flag criteria for identifying cardiac disease causing chest pain and technical charges of low-probability referrals. Accuracy of red-flag criteria was ascertained through study of chest pain Standardized Clinical Assessment and Management Plans (SCAMPs®) data. Patients were divided into 2 groups: Group1 (concerning clinical elements) and Group2 (without). We compared incidence of cardiac disease causing chest pain between these 2 groups. Technical charges of Group 2 were analyzed using the Pediatric Health Information System database. Potential savings for the US population was estimated using National Ambulatory Medical Care Survey data. Fifty-two percent of subjects formed Group 1. Cardiac disease causing chest pain was identified in 8/1656 (0.48%). No heart disease was identified in patients in Group 2 ( P = .03). Applying red-flags in determining need for referral identified patients with cardiac disease causing chest pain with 100% sensitivity. Median technical charges for Group 2, over a 4-year period, were US2014$775 559. Eliminating cardiac testing of low-probability referrals would save US2014$3 775 182 in technical charges annually. Red-flag criteria were an effective screen for children with chest pain. Eliminating cardiac testing in children without red-flags for referral has significant technical charge savings.

Keywords: chest pain; pediatric cardiology; quality improvement; subspecialty referral.

MeSH terms

  • Adolescent
  • Ambulatory Care / economics
  • Ambulatory Care / methods
  • Cardiology / economics
  • Cardiology / methods*
  • Cardiovascular Diseases / complications
  • Cardiovascular Diseases / diagnosis*
  • Chest Pain / diagnosis*
  • Chest Pain / etiology
  • Child
  • Databases, Factual
  • Diagnosis, Differential
  • Echocardiography
  • Electrocardiography
  • Exercise Test
  • Female
  • Guideline Adherence
  • Humans
  • Male
  • Pediatrics / economics
  • Pediatrics / methods*
  • Practice Guidelines as Topic
  • Probability
  • Quality Improvement*
  • Referral and Consultation*
  • Retrospective Studies
  • Sensitivity and Specificity
  • United States