Utilization of the electrocardiogram in the pediatric emergency department - 24/02/21
, Joseph Arms, MD a, Gretchen Cutler, PhD a, Ernest Krause, MS a, David Burton, MD a, cAbstract |
Objective |
Review pediatric electrocardiogram (ECG) result severity classification and describe the utilization of ECG testing, and rate of clinically significant results, in the pediatric emergency department (PED).
Methods |
This was a review of patients ≤18 years who had an ECG performed in a tertiary children's hospital PED 2005–2017. Using established guidelines and expert consultation, ECG results were categorized: Class 0 = normal, Class I = mild abnormality (no cardiology follow-up), Class II = moderate abnormality (cardiology follow-up), Class III = severe abnormality (immediate intervention). Chi-square tests were used to examine differences between patients with clinically insignificant (Class 0/I) and clinically significant (Class II/III) results. Multivariable regression was used to examine factors associated with clinically significant results.
Results |
16,147 unique PED encounters with ECG performed were included for analysis. The most common ECG indications were chest pain (32.5%), syncope (22.0%), arrhythmia (11.8%), toxicology/ingestion (9.4%), and seizure (5.7%). Overall, 12.7% (n = 2056) of ECGs had clinically significant (Class II/III) results, and only 2.0% (n = 325) had severe abnormality (Class III) that would require immediate intervention or cardiologist input. Factors associated with increased odds of clinically significant ECG were age ≤ 1 year (OR = 1.20, 95% CI: 1.02–1.41), male (OR = 1.33, 95% CI: 1.20–1.46), and indications of arrhythmia (OR = 1.84, 95% CI: 1.59–2.13), cardiac (OR = 2.57, 95% CI: 1.99–3.31), blank indication (OR = 1.52, 95% CI: 1.17–1.98), and electrolyte abnormality (OR = 1.42, 95% CI: 1.03–1.95).
Conclusions |
In this study, we provided a valuable review of ECG result severity classification in the pediatric population. We found that chest pain and syncope represented over half of all ECGs performed. We found that clinically significant results are rare in the pediatric population at 12.7% of all ECGs performed, and very few (2.0%) have severe abnormalities that would require immediate intervention. Those with increased odds of a clinically significant ECG include young patients ≤1 year of age, male patients, and certain ECG indications.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Pediatric electrocardiogram results can be classified based on clinical severity. |
• | Review of this classification promotes better understanding of pediatric results. |
• | Clinically significant electrocardiogram results are rare in the pediatric population. |
• | Only 2% of pediatric electrocardiograms required emergency intervention. |
Keywords : Pediatric, Pediatric emergency medicine, PEM, Electrocardiogram, ECG, EKG
Abbreviations : Electrocardiogram, pediatric emergency department, electronic medical record, odds ratio, confidence interval, AV block, bundle branch block, right bundle branch block, premature atrial contraction, premature ventricular contraction, right ventricular, left ventricular, right ventricular hypertrophy, left ventricular hypertrophy, biventricular hypertrophy, supraventricular tachycardia, wolff-parkinson-white, apparent life-threatening event, altered mental status, left axis deviation
Plan
Vol 41
P. 21-27 - mars 2021 Retour au numéro
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