Clinical audit of the management of pericarditis in children in a Tertiary Referral University Hospital in Egypt

Background
Globally, pericarditis is the commonest form of pericardial disease. Pediatric pericarditis has diverse etiologies and its available epidemiological data and management guidelines are sparse.
Objective
To evaluate the management of children with pericarditis attending Assiut University Children Hospital according to the European Society of Cardiology (ESC) guidelines (2015).
Patients and methods
This descriptive study was conducted at Assiut University Children Hospital, Assiut, Egypt, during the period of 1 year (from June 2017 to June 2018). During the study period, 30 children with pericarditis (due to different causes) were included (14 males and 16 females). Full history, cause of pericarditis, symptoms, and signs were taken. Some investigations, including laboratory and radiological were recorded. Therapy and medication and the outcome measures were assessed. In addition, the approach of doctors toward the application of the ESC guidelines was investigated.
Results
Idiopathic pericarditis was the most common cause of pericarditis (43.3%) followed by renal (20.0%), autoimmune (16.7%), tuberculosis (10.0%), and malignant (10.0%) causes. Chest pain (61–100%) followed by dyspnea (40.0%) was the most common presenting symptom. Tachycardia was a common sign in all cases, followed by muffled heart sound (in approximately two-thirds of cases), friction rub, jugular vein distention, and pulsus paradoxus, successively. Of the 30 included cases, 14 (46.6%) cases improved, nine (30.0%) cases got recurrent pericarditis, and seven (23.3%) cases died.
Conclusion
The ESC guidelines (2015) help improve the management of pediatric pericarditis. It was followed by a reasonable percentage of our cases. It is strongly recommended for doctors to be trained to apply these guidelines. Future multicenter, long-term prospective studies are needed to develop therapeutic recommendations for pericarditis in pediatric patients in addition to understanding the pathophysiology for improving the outcome.