Paediatric Chest Pain: Evaluating Diagnostic Testing and Clinical Outcomes

Background Chest pain is a common reason for referral to paediatric cardiology clinics. Unlike adults, most paediatric chest pain is benign, yet uncertainty often leads to additional testing. Aim To evaluate the aetiology of chest pain in children referred to a tertiary paediatric cardiology clinic, determine the diagnostic yield of additional tests, and identify patients who truly benefit from further investigations. Methods A retrospective observational study of 368 children (5–18 years) presenting with chest pain among 1,631 outpatient visits was conducted. All patients underwent a detailed history and physical examination, as well as an electrocardiogram (ECG). Additional tests, including echocardiography, chest radiography, and laboratory analysis, were performed when indicated. Clinical records were reviewed to categorise diagnoses and assess diagnostic yield. Results Cardiac causes were identified in 8 patients (2.2%), whereas 360 patients (97.8%) had non-cardiac aetiology: musculoskeletal (46.2%), idiopathic (24.9%), respiratory (18.8%), gastrointestinal (2.8%), psychogenic (5.8%), and miscellaneous (1.1%). ECG abnormalities were detected in 16 patients (4.3%), echocardiography was positive in 5/208 patients (2.4%), and cardiac biomarkers were abnormal in 2/15 (13.3%). Most additional tests were low yield, highlighting limited diagnostic value in the absence of red flags. Conclusion Most paediatric chest pain is benign. A structured approach relying on history and physical examination can identify patients requiring further evaluation. Targeted testing based on clinical risk factors could reduce unnecessary investigations, optimise resource use, and improve patient care.