Within this page, you will find Industry Perspective blogs written by the UCA Corporate Support Partners (CSP); Insights from UCA Chief Executive Officer Lou Ellen Horwitz; Practice Management blogs to help you better manage center operations; and bonus UCA education in Educational Insights.


EDUCATIONAL INSIGHTS: UCA2019 Convention Take Home Tactics Dose 1: Chest Pain in Children

Posted: May 13, 2019
Comments: 0
Author: UCA Admin

The 2019 Urgent Care & Convention is now over … but we want to continue to offer our members the best of our educational content throughout the summer months with our first UCA Summer School!   

We want to make sure you are continuing the conversations started at the convention by giving you Take-Home Tactics.  The idea?  Provide easy-to-execute pearls of wisdom from some of our most popular sessions. Share this email with your staff as a way of offering everyone the opportunity to change the way they look at on-demand medicine.  Be on the lookout throughout the upcoming months for new Take Home Tactics and get #UCASummerSchool this summer!

Chest Pain in Children and Adolescents:  Pitfalls and Pearls

Children and adolescents presenting to urgent cares with a complaint of chest pain can be anxiety-provoking for the patient, parents and for healthcare providers. Dr. Tom Tryon offered the distinction between cardiac and non-cardiac chest pain along with information on the most common causes of chest pain in children.  Additionally, he offered a structured approach to evaluating children and adolescents with chest pain to determine when additional evaluation is needed or when patient and parent reassurance is appropriate.

Dr. Tryon says …

Take Home Tactic #1: Chest pain in children and adolescents is relatively common, but a cardiac etiology is relatively rare (less than 2% of all cases).

“Statistics show that over 650,000 visits from patients age 12-21 were related to chest pain and 98% of those are non-cardiac in origin.  One-third of these chest pain cases are related to Costochondritis, Tietze Syndrome, Idiopathic Chest Wall Pain, Slipping-rib Syndrome, muscle strain-overuse injury, Sickle cell vaso-occlusive crisis and Xiphoid pain (xiphoidalgia).”

Take Home Tactic #2: Most chest pain in children and adolescents is due to some form of chest wall pain.

“Some of the most common causes include Costochondritis, which presents with sharp, stabbing pain along two or more successive upper costochondral joints.  The pain worsens with deep breaths and coughing.  No outward sign of inflammation and the pain can be reproduced with manual palpation along affected costochondral joints.  Idiopathic chest wall pain is most common with sharp pain localized to the middle of the sternum or inframammary area, lasting a few minutes.  Pain is worsened by manual pressure on the rib cage or sternum or deep breathing.  Other causes, like Tieze Syndrome, more commonly seen in adolescents typically show signs of inflammation and can be caused by a recent upper respiratory infection.”     

Take Home Tactic #3: Consideration of gastrointestinal, psychiatric causes and possible pulmonary considerations of chest pain should be considered when evaluating chest pain in a child or adolescent.

“One study shows that GI causes represent 8% of chest pain. These causes can be peptic ulcer disease, Gastroesophageal reflux disease, Cholecystitis, Esophageal spasm or foreign body ingestion.  Additionally, be on the look out for adolescents dealing with stress, anxiety or even sleeping problems.  Finally, there are the pulmonary issues like inflammation, Cardiomyopathy, Arrhythmias, stenosis and other miscellaneous issues, including drug use can be causes to watch for.  These “reg flags” can be helpful in your diagnosis:

  • Exertional
  • Acute onset
  • Awakens from sleep
  • Substernal crushing pressure
  • Radiation to shoulder, arm, neck, jaw or back
  • Syncope or dizziness
  • Palpitations
  • Dyspnea
  • Orthopnea
  • Pulmonary embolus risk factors
  • Illicit drug use


Dr. Tom Tryon is a clinical urgent care physician and is the former Associate Division Director of the Section of Urgent Care for Children’s Mercy Hospital in Kansas City and a Professor of Pediatrics at the University of Missouri – Kansas City (UMKC) School of Medicine.  Dr. Tryon has been a full time pediatric urgent care physician since 2006.  In his previous leadership role, he oversaw the building, development and clinical operations of three pediatric urgent care centers, including a staff of approximately 70 physicians.  He and wife, Jackie, a pediatric nurse, have four children (all pursuing medicine) and reside in Missouri.





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