Researchers Develop New Procedure For Evaluating Pediatric Chest Pain

Less than one percent of children with chest pain have cardiac diseases, but current procedures involve extensive testing anyway.

Outpatient clinics at Boston Children’s Hospital looked at 3,700 patients ages 7 to 22 who were brought in for chest pain over the course of nine years (2000-2009). Each of these patients went through testing that ranged from extensive to very minimal, and in the end, less than one percent were diagnosed with cardiac disease.

Based on this information, researchers conducted a study at Boston Children’s Hospital and the New England Congenital Cardiology Association (NECCA), realizing that the tests performed on these patients could be more effective by developing a Standardized Clinical Assessment and Management Plan, or a SCAMP.

By examining 1,016 ambulatory child patients who presented with chest pains, the researchers were able to put together a SCAMP algorithm that took into account patient history, a physical exam, and an electrocardiogram in order to determine what testing was needed for each patient. Once this SCAMP was exhausted, if no diagnosis was reached, then doctors could move on to more extensive testing.

Without using this SCAMP algorithm, the study showed, many doctors ordered a large amount of expensive tests. Implementing this SCAMP algorithm in the study decreased the amount of unnecessary testing on child cardiac patients and decreased the chances of necessary tests being overlooked.

The cost of SCAMP is also lower than the previous standard procedures for evaluating chest pain in patients. Dr. David Fulton, senior author and chief of outpatient cardiac services at Boston Children’s Hospital reported a 15 to 20 percent decrease in overall costs when using the SCAMP process.

The study, because it was a collaborative effort between Boston Children’s and the NECCA, also gave researchers the opportunity to compare procedures between multiple facilities. They discovered that the overall pattern of care for pediatric cardiac patients at Boston Children’s and the NECCA differed minimally.

In a press release, Fulton said:

“The willingness for collaboration for this study across New England facilities represents the collective responsibility among today’s physicians to reduce testing and health care costs, when appropriate, while improving the quality of care delivery.”