Cardiology 2013 (Full reference info)

Reference Type: Journal Article
Record Number: 542Author: Angoff, G. H., Kane, D. A., Giddins, N., Paris, Y. M., Moran, A. M., Tantengco, V., Rotondo, K. M., Arnold, L., Toro-Salazar, O. H., Gauthier, N. S., Kanevsky, E., Renaud, A., Geggel, R. L., Brown, D. W. and Fulton, D. R.
Year: 2013
Title: Regional implementation of a pediatric cardiology chest pain guideline using SCAMPs methodology
Journal: Pediatrics
Volume: 132
Issue: 4
Pages: e1010-7
Date: Oct
Short Title: Regional implementation of a pediatric cardiology chest pain guideline using SCAMPs methodology
Alternate Journal: Pediatrics
ISSN: 1098-4275 (Electronic)
0031-4005 (Linking)
DOI: 10.1542/peds.2013-0086
Accession Number: 24019419
Keywords: Adolescent
Ambulatory Care/methods
Chest Pain/*diagnosis/physiopathology/therapy
Child
Disease Management
Echocardiography/methods/*standards
Electrocardiography/methods/*standards
Female
Follow-Up Studies
Guideline Adherence
Heart Diseases/*diagnosis/physiopathology/therapy
Humans
Male
Pediatrics/*methods
Practice Guidelines as Topic/*standards
Radiography, Thoracic/standards
Young Adult
Abstract: BACKGROUND AND OBJECTIVES: Chest pain is a complaint for which children are frequently evaluated. Cardiac causes are rarely found despite expenditure of considerable time and resources. We describe validation throughout New England of a clinical guideline for cost-effective evaluation of pediatric patients first seen by a cardiologist for chest pain using a unique methodology termed the Standardized Clinical Assessment and Management Plans (SCAMPs). METHODS: A total of 1016 ambulatory patients, ages 7 to 21 years initially seen for chest pain at Boston Children’s Hospital (BCH) or the New England Congenital Cardiology Association (NECCA) practices, were evaluated by using a SCAMPs chest pain guideline. Findings were analyzed for diagnostic elements, patterns of care, and compliance with the guideline. Results from the NECCA practices were compared with those of Boston Children’s Hospital, a regional core academic center. RESULTS: Two patients had chest pain due to a cardiac etiology, 1 with pericarditis and 1 with an anomalous coronary artery origin. Testing performed outside of guideline recommendations demonstrated only incidental findings. Patients returning for persistent symptoms did not have cardiac disease. The pattern of care for the NECCA practices and BCH differed minimally. CONCLUSIONS: By using SCAMPs methodology, we have demonstrated that chest pain in children is rarely caused by heart disease and can be evaluated in the ambulatory setting efficiently and effectively using minimal resources. The methodology can be implemented regionally across a wide range of clinical practice settings and its approach can overcome a number of barriers that often limit clinical practice guideline implementation.
Notes: Angoff, Gerald H
Kane, David A
Giddins, Niels
Paris, Yvonne M
Moran, Adrian M
Tantengco, Victoria
Rotondo, Kathleen M
Arnold, Lucy
Toro-Salazar, Olga H
Gauthier, Naomi S
Kanevsky, Estella
Renaud, Ashley
Geggel, Robert L
Brown, David W
Fulton, David R
eng
Multicenter Study
Research Support, Non-U.S. Gov’t
2013/09/11 06:00
Pediatrics. 2013 Oct;132(4):e1010-7. doi: 10.1542/peds.2013-0086. Epub 2013 Sep 9.
URL: http://www.ncbi.nlm.nih.gov/pubmed/24019419
Author Address: Cardiology Outpatient Services, Department of Cardiology, Children’s Hospital Boston, 300 Longwood Ave, Boston, MA 02115. david.fulton@cardio.chboston.org.

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