Abstract
IMPORTANCE: Nontraumatic chest pain is a common clinical presentation, but less is known about it in children seeking emergency medical services (EMS) care. OBJECTIVE: To determine the incidence, diagnoses, and outcomes of pediatric EMS-attended nontraumatic chest pain. DESIGN, SETTING, AND PARTICIPANTS: This retrospective, population-based cohort study was conducted between January 1, 2015, and June 30, 2019, in Victoria, Australia using linked EMS, emergency department (ED), hospital, and state death index datasets. Children younger than 18 years who contacted EMS for nontraumatic chest pain were included. Data analyses were completed on July 16, 2025. EXPOSURE: EMS attendance for nontraumatic chest pain. MAIN OUTCOMES AND MEASURES: The primary end point was a serious outcome within 72 hours, defined as death, cardiac arrest, ED triage category 1 (resuscitation), or intensive care unit (ICU) admission. Multivariable logistic regression identified factors associated with serious outcomes. RESULTS: Among 4277 pediatric EMS attendances, the median (IQR) age was 14 (11-16) years, and 2506 (58.6%) were female. The overall incidence was 60.0 (95% CI, 58.0-62.0) per 100 000 person-years, with higher rates in females (67.7 [95% CI, 64.9-70.6] cases per 100 000 person-years), adolescents aged 12 to 17 years (128.0 [95% CI, 123.2-133.1] cases per 100 000 person-years), and children from the most disadvantaged areas (78.4 [95% CI, 73.6-83.6] cases per 100 000 person-years). Most cases (3395 [79.4%]) received time-critical EMS dispatch, 3263 (76.3%) were transported to hospital, and 1586 (59.1%) were triaged as urgent (category 3) in the ED. The most common diagnoses were nonspecific chest pain (1131 patients [42.2%]) and respiratory disorders (476 patients [17.7%]); cardiovascular diagnoses were uncommon (191 patients [7.1%]). Within 72 hours, serious outcomes occurred in 44 patients (1.6%). In multivariable models, abnormal initial vital signs including heart rate (odds ratio [OR], 3.50; 95% CI, 1.75-6.97), systolic blood pressure (OR, 6.47; 95% CI, 1.95-21.48), hypoxemia (OR, 5.73; 95% CI, 2.28-14.39), and reduced consciousness (OR, 6.03; 95% CI, 2.40-15.10) were associated with serious outcomes. CONCLUSIONS AND RELEVANCE: In this cohort study of children seeking EMS care for nontraumatic chest pain, most cases were benign and rarely of cardiac origin, and abnormal vital signs at EMS assessment were associated with increased risk of serious outcomes. These findings support the need for improved triage systems and risk stratification to guide safe and appropriate care.