Abstract
Previously undiagnosed pediatric cardiac disease represents a clinical challenge for
the emergency physician. The clinical presentation of these disorders can mimic other
conditions of the respiratory, gastrointestinal and neurologic systems at a time when
the need for early identification and treatment is at a premium. A high index of suspicion
and superb clinical acumen is required to make a timely diagnosis and initiate optimal
care.
Methods
A retrospective chart review using explicit criteria and a structured data collection
process was performed on all children presenting with previously undiagnosed cardiac
disease over a five and half year period.
Results
Thirty-six patients were identified over a five and a half year period representing
one patient per 4838 pediatric ED presentations. A diverse set of chief complaints,
triage categories, clinical presentations and diagnoses were identified. Undiagnosed
congenital lesions, acquired cardiac disease, dysrhythmias and infectious diseases
of the heart were represented. The need for surgical intervention (22%) and mortality
(6%) was substantial.
Conclusion
In the aggregate, these conditions occur at an important rate and represent a high
risk subset of pediatric patients presenting to the emergency department. Individually,
the conditions occur infrequently and ‘pattern recognition’ may not aid the clinician.
Early diagnosis and prompt intervention is important in this population.
Keywords
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Article Info
Publication History
Published online: February 21, 2019
Accepted:
February 21,
2019
Received in revised form:
February 9,
2019
Received:
November 5,
2018
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
