Diagnosis: Costochondritis

Treatment: Inpatient Admission

The insurer denied the Inpatient Admission. The denial was upheld

This is a female child who presented to the Emergency Room with complaints of mid- sternal chest pain. She described her pain as aching and crushing, and that it had worsened over the past week. She has a history of asthma. Cardiology consulted on the patient. She had a chest X-ray and electrocardiogram that were both normal. Serial Troponin level drawn and were within normal limits. Her vital signs remained stable. The patient was discharged home when her symptoms improved.

The following rationale is provided concluding that the denial should be upheld.
1) Chest pain in children although common is rarely of cardiac etiology and the reproducible nature of the pain on palpation and its worsening with deep breathing is clearly against an ischemic etiology.
2) The cardiac causes of chest pain which could be considered in this case of child are pericarditis and myopericarditis. These diagnoses would be considered with an abnormal ECG. There were no ST elevations, or low voltages to suggest these diagnoses. An echocardiogram was performed (normal), despite published Appropriate Use Criteria (ref below) indicated that an echocardiogram is rarely appropriate in this instance. In addition the echocardiogram could have been done during an observational period.
3) Troponin levels in the pediatric age group are not needed in the face of a normal ECG. In addition the lab report states "Result. (Between 0.04 mg/mL to .29mg/mL) must be clinically correlated as conditions other than cardiac ischemia could yield the result".
The carrier's denial of coverage for inpatient hospital admission is upheld.