Aims Chest pain in children is a common presentation in the ED. It is known that chest pain in children, in comparison to adults, is less likely to represent a cardiovascular origin. Electrocardiographs (ECGs) are a relatively cheap and fast investigation, and can reveal cardiac causes of chest pain through appropriate interpretation. We aim to determine the likely causes of chest pain presenting to our Children’s ED and analyse the use of ECG in these cases.

Methods We retrospectively analysed the use of ECGs in children presenting with chest pain over the preceding year.

Results The Children’s ED had 30,000 attendances over the preceding year; 345 attendances presented with chest pain. The commonest age ranges to present were 15–16 year olds, followed by 10–11 year olds; there were slightly more male than female patients attending with chest pain.

The most likely final diagnosis recorded was musculoskeletal; a cardiovascular diagnosis was found in only 1% of patients presenting with chest pain.

In our cohort, 51% of patients had an ECG performed during their attendance. Patients with cardiovascular, psychiatric and musculoskeletal diagnoses were most likely to have an ECG performed. Further analysis reveals that the majority of ECGs were normal (97%); the remainder reveal changes that could attribute to chest pain.

Conclusion In conclusion, our retrospective analysis reveals that although chest pain in children is common, it is unlikely to represent cardiac disease. However, ECG is utilised in over half of our cohort, with the majority of patients not revealing any abnormalities suggestive of cardiac origins for chest pain. Indeed, ECG is a good screening tool to rule out ischaemic changes and arrhythmias leading to chest pain.

To continue this study further, we aim to to review chest pain attendances over the preceding 5 years, not only identifying abnormal ECGs, but also to review if appropriate interpretation and subsequent management is being performed in ED.