Pediatric chest pain in the emergency department: a narrative review and a practical diagnostic approach

Background Chest pain in children is a common presentation in the emergency department (ED) and often generates significant parental concern [1, 2]. Although most cases are benign - most frequently musculoskeletal or gastrointestinal in origin - some presentations require prompt recognition of potentially serious conditions [3, 4]. Purpose We propose a multidisciplinary flowchart specifically designed for pediatric ED triage that integrates cardiological, respiratory, gastrointestinal, hematologic, poisoning and psychogenic considerations. Unlike existing pathways, this flowchart emphasizes rapid assessment, structured decision-making, and practical guidance for emergency clinicians, without replacing specialist consultation [5, 6]. Methods We conducted a narrative review using a structured methodology, searching PubMed, Scopus, and CINAHL for studies published in English between 2015 and 2025, focusing on pediatric patients (≤ 18 years) presenting with chest pain [2, 3, 7]. Relevant articles were screened, summarized, and integrated with clinical experience to develop a structured flowchart based on expert opinion [4, 5]. Results Causes of pediatric chest pain were categorized as cardiovascular (29%), musculoskeletal (13%), respiratory (25%), oncohematologic (13%), gastrointestinal (6%), poisoning and psychogenic (remaining cases) [1, 8, 9]. The flowchart outlines key steps for clinical assessment, diagnostic workup, and referral, including pain scoring, electrocardiography, imaging, and laboratory testing [6, 7]. It is explicitly labeled as expert opinion–based and highlights areas requiring local adaptation [5]. A step-by-step guide tailored for ED implementation is provided. Conclusions Although chest pain in children is usually benign, careful evaluation is essential to identify potentially serious conditions. The proposed ED flowchart offers a structured, multidisciplinary, and ED-specific approach, supporting triage and early decision-making [1, 3]. Limitations include the need for local adaptation and the lack of formal validation. Early recognition of red flags and appropriate triage may improve patient outcomes [6, 7].