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.

TitlePediatric 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.
Publication TypeJournal Article
Year of Publication2017
AuthorsHarahsheh AS, O'Byrne ML, Pastor B, Graham DA, Fulton DR
JournalClin Pediatr (Phila)
Volume56
Issue13
Pagination1201-1208
Date Published2017 Nov
ISSN1938-2707
KeywordsAdolescent, Ambulatory Care, Cardiology, Cardiovascular Diseases, Chest Pain, Child, Databases, Factual, Diagnosis, Differential, Echocardiography, Electrocardiography, Exercise Test, Female, Guideline Adherence, Humans, Male, Pediatrics, Practice Guidelines as Topic, Probability, Quality Improvement, Referral and Consultation, Retrospective Studies, Sensitivity and Specificity, United States
Abstract

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.

DOI10.1177/0009922816684605
Alternate JournalClin Pediatr (Phila)
PubMed ID28081617