가슴불편감으로 응급실을 방문한 청소년의 임상적 특성: 기저질환 인식의 중요성
Clinical features of adolescents who visited the emergency department with chest discomfort: the importance of recognizing underlying medical conditions
김지원, 박에스더, 박미란, 조중범, 손명희,
소속 상세정보
김지원 ( Kim Ji-Won )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Pediatrics
박에스더 ( Park Esther )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Critical Care Medicine
박미란 ( Park Mi-Ran )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Pediatrics
조중범 ( Cho Joong-Bum )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Critical Care Medicine
손명희 ( Son Meong-Hi )
Sungkyunkwan University School of Medicine Samsung Medical Center Department of Pediatrics
Abstract
Purpose: We aimed to evaluate the clinical features of adolescents who visit emergency departments (EDs) with chest discomfort, and analyze the implications of underlying medical conditions for the development of cardiogenic chest discomfort.
Methods: We reviewed the medical records of adolescents (13-18 years) with chest discomfort who visited a tertiary hospital ED in Seoul, Korea from 2014 through 2018. Sex, age, duration and character of the discomfort, symptoms and signs, ED length of stay, abnormal findings of vital signs, chest radiograph, electrocardiogram, and elevated concentrations of cardiac enzymes were reviewed. Final diagnosis was based on cardiac evaluations within 1 year after the index visit. Underlying medical conditions were defined as visits to the cardiology, pulmonology or hematology-oncology clinics at least twice in the preceding year. Initial suspicious clinical findings were defined as palpitation, syncope or high blood pressure. Logistic regression was used to identify predictors for cardiac etiology.
Results: Of the 231 patients, 43 (18.6%) and 69 (29.9%) had underlying medical conditions and initial suspicious clinical findings, respectively. The predictors for cardiac etiology were underlying medical conditions (odds ratio, 4.28; 95% confidence interval, 1.09-16.73), initial suspicious clinical findings (4.77; 1.36-16.77), abnormal electrocardiogram (11.54; 3.22-41.32), and elevated concentration of troponin I (66.52; 5.37-823.55). The patients with cardiogenic chest discomfort had a longer median ED length of stay (281.0 minutes [interquartile range, 215.5-369.0] vs. 199.5 [132.8-298.0]; P = 0.004) and a higher hospitalization rate (48.3% vs. 13.4%; P < 0.001) than those with non-cardiogenic chest discomfort.
Conclusion: It may be necessary to recognize underlying medical conditions and initial suspicious clinical findings in EDs prior to cardiac evaluation in adolescents with chest discomfort.
키워드
Adolescent; Cardiology; Chest Pain; Emergency Service, Hospital; Risk Factors
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