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Use of the Electrocardiogram in a Pediatric Emergency Department

Lisa A. Horton, MD; Sheila Mosee, MD; Joel Brenner, MD
Arch Pediatr Adolesc Med. 1994;148(2):184-188. doi:10.1001/archpedi.1994.02170020070012.
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Objective:  To ascertain the quality of electrocardiogram (ECG) use in a pediatric emergency department (PED).

Research Design:  Patient series.

Setting:  Pediatric emergency department in a university-based hospital.

Participants:  Seventy patients, aged 2 months to 22 years.

Measurements:  All ECGs obtained in the PED were received by the Division of Pediatric Cardiology during the 15-month study period. The charts of all patients were then reviewed to determine the (1) indications for obtaining an ECG; (2) accuracy of documentation; (3) impact of ECG results on the treatment of patients; and (4) concordance between PED and pediatric cardiologists in ECG interpretation.

Results:  Chest pain was the most commonly documented indication, accounting for 54% of the ECGs obtained. Other indications were suspected arrhythmias (11%), seizure and syncope (11%), drug exposure (8%), and miscellaneous (16%). Twelve charts (17%) lacked documentation of ECG results. Ten ECGs (14%) were performed improperly. Twenty three (32%) were interpreted differently by the pediatric cardiologists; 14 ECGs (20%) had potential clinical relevance. Thirty-seven (52%) ECGs were useful in patient care; this was significantly associated with the presence of a PED attending (P=.03 by Fisher's Exact Test).

Conclusion:  We recommend education of pediatric residents in ECG interpretation and subsequent review by a pediatric cardiologist of each ECG performed in the PED.(Arch Pediatr Adolesc Med. 1994;148:184-188)

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