Chest pain—indications for further action
| Investigation/intervention | Indication |
|---|---|
| CXR | Acute onset of severe pain |
| Pain awakening from sleep | |
| History of drooling, foreign body ingestion | |
| Cough | |
| Fever | |
| Dyspnoea | |
| History/signs of significant trauma | |
| Abnormal pulmonary/cardiac auscultation | |
| Trial anti-reflux medication/pH/impedance monitoring | Gastrointestinal-type pain (see text) |
| Epigastric tenderness | |
| ECG | Cardiac-type chest pain (see text) |
| Further resources on interpretation of the paediatric ECG are available elsewhere17 18 | Cardiac red flags (see box 1) |
| Pericarditic pain (see text) | |
| Any abnormal chest sensation/pain in a preschool child | |
| Palpitations | |
| Abnormal cardiac auscultation or diminished pulses | |
| Abnormal heart rate or rhythm | |
| Family history of sudden death, inherited arrhythmias, cardiomyopathy or ICD/pacemaker insertion | |
| Referral to paediatric cardiology | Cardiac-type chest pain (particularly exertional) |
| Abnormal ECG | |
| Potentially inherited cardiac disease | |
| Abnormal cardiovascular examination | |
| Exercise-induced syncope or dizziness | |
| Palpitations or cyanosis |
CXR, chest radiograph; ICD, implantable cardioverter defibrillators.