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Chest Pain and Syncope in Children: A Practical Approach to the Diagnosis of Cardiac Disease

2013; Elsevier BV; Volume: 163; Issue: 3 Linguagem: Inglês

10.1016/j.jpeds.2013.05.001

1097-6833

Kevin G. Friedman, Mark E. Alexander,

Congenital Heart Disease Studies

Chest pain and syncope are common in children, accounting for numerous provider visits and leading to a considerable amount of testing. 1 Driscoll D.J. Glicklich L.B. Gallen W.J. Chest pain in children: a prospective study. Pediatrics. 1976; 57: 648-651 PubMed Google Scholar , 2 Danduran M.J. Earing M.G. Sheridan D.C. Ewalt L.A. Frommelt P.C. Chest pain: characteristics of children/adolescents. Pediatr Cardiol. 2008; 29: 775-781 Crossref PubMed Scopus (48) Google Scholar , 3 Friedman K.G. Kane D.A. Rathod R.H. Renaud A. Farias M. Geggel R. et al. Management of pediatric chest pain using a standardized assessment and management plan. Pediatrics. 2011; 128: 239-245 Crossref PubMed Scopus (86) Google Scholar , 4 Verghese G.R. Friedman K.G. Rathod R.H. Meiri A. Saleeb S.F. Graham D.A. et al. Resource utilization reduction for evaluation of chest pain in pediatrics using a novel Standardized Clinical Assessment and Management Plan (SCAMP). J Am Heart Assoc. 2012; 1 Crossref PubMed Scopus (36) Google Scholar , 5 DiVasta A.D. Alexander M.E. Fainting freshmen and sinking sophomores: cardiovascular issues of the adolescent. Curr Opin Pediatr. 2004; 16: 350-356 Crossref PubMed Scopus (10) Google Scholar , 6 McLeod K.A. Syncope in childhood. Arch Dis Child. 2003; 88: 350-353 Crossref PubMed Scopus (64) Google Scholar , 7 Ritter S. Tani L.Y. Etheridge S.P. Williams R.V. Craig J.E. Minich L.L. What is the yield of screening echocardiography in pediatric syncope?. Pediatrics. 2000; 105: E58 Crossref PubMed Scopus (80) Google Scholar The Centers for Medicare and Medicaid Services projects that health care spending will exceed 20% of the US Gross Domestic Product by 2018. 8 Borger C. Smith S. Truffer C. Keehan S. Sisko A. Poisal J. et al. Health spending projections through 2015: changes on the horizon. Health Aff (Millwood ). 2006; 25: w61-w73 Crossref PubMed Scopus (166) Google Scholar Considering the looming crisis in health care finance and impending changes in the US health care delivery system, provider-driven methods to optimize resource utilization are critical. Careful evaluation of current practices, with particular attention to use of expensive and overutilized resources, is needed.