Related Experiment Video
Updated: Aug 14, 2026
Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Accuracy of ECG interpretation in the pediatric emergency department
Joe E Wathen1, Arleta B Rewers, Anji T Yetman
1Division of Emergency Medicine, Department of Pediatrics, University of Colorado, Denver and Health Sciences Center/The Children's Hospital, Denver, CO, USA. wathen.joseph@tchden.org
Insights
Pediatric emergency physicians accurately interpret most electrocardiograms (ECGs), with high concordance with cardiologists. However, clinically significant findings may be missed, suggesting a need for specialist review.
Area of Science:
- Pediatric Cardiology
- Emergency Medicine
- Electrocardiography
Background:
- Electrocardiograms (ECGs) are crucial diagnostic tools in pediatric emergency care.
- Accurate interpretation of pediatric ECGs is essential for timely and appropriate management.
- Variability in interpretation may exist between emergency physicians and pediatric cardiologists.
Purpose of the Study:
- To evaluate the accuracy of ECG interpretation by pediatric emergency department (ED) physicians.
- To determine common indications for obtaining ECGs in pediatric patients.
- To develop a clinical classification system for ECG abnormalities in children.
Main Methods:
- Prospective acquisition of ECG data from pediatric patients (0-21 years) in an ED.
- Comparison of initial ED physician interpretation against a pediatric cardiologist's criterion standard.
- Blinded review of discordant interpretations by a cardiology panel.
- Development and application of a standardized ECG abnormality classification system.
Main Results:
- 1,653 ECGs from 1,501 pediatric patients were analyzed.
- Common indications included chest pain, seizure, syncope, and arrhythmias.
- 71% of ECGs were normal (class 0), with 29% showing abnormalities (classes I-III).
- Concordance between ED physicians and cardiologists was 0.73 (95% CI 0.70-0.77).
- ED interpretation showed 75% sensitivity and 98.5% specificity.
Conclusions:
- High overall concordance exists between pediatric ED physicians and cardiologists for ECG interpretation.
- Most discordant ECGs are not clinically significant.
- Clinically significant ECG discrepancies highlight the importance of pediatric cardiologist review to prevent underdetection.
Study Objective:
We assess accuracy of ECG interpretation and indications for obtaining ECGs and develop a clinical classification system of ECG abnormalities.
Methods:
Prospectively acquired ECG data on patients 0 to 21 years of age and presenting to our pediatric emergency department (ED) were obtained. Clinical indications were documented. The initial ECG interpretation (pediatric ED attending physician) was compared with the criterion standard (pediatric cardiologist). A blinded cardiology panel reviewed discrepancies, and a final concordance rate was determined. An ECG abnormality classification system was developed and used to categorize these abnormal ECGs.
Results:
One thousand six hundred fifty-three ECGs from 1,501 patients, aged 2 days to 21 years (median 10.0 years), were obtained during 3.5 years. Fifty-one percent were male patients. ECG indications included chest pain (21%), seizure or syncope (18%), arrhythmias (17%), apparent life-threatening event or respiratory symptoms (16%), ingestions (10%), cardiac abnormality (10%), and miscellaneous (8%). From 1,631 ECGs, 1,160 (71%) were normal (class 0), 259 (16%) were minimally abnormal (class I), 174 (11%) were moderately abnormal (class II), and 38 (2%) were severely abnormal (class III). Kendall's tau-b test showed concordance of 0.73 (95% confidence interval 0.70 to 0.77) between pediatric ED and cardiology interpretation. The sensitivity of pediatric ED interpretation was 75%, and the specificity was 98.5%. The positive predictive value of pediatric ED interpretation was 88.3%, and the negative predictive value was 96.3%.
Conclusion:
We conclude that, overall, a high rate of concordance exists between the pediatric emergency physician's and the cardiologist's ECG interpretation. The majority of discordant ECGs are not clinically significant. However, among the clinically significant ECGs, there is a higher rate of discordance. These data suggest that review of pediatric ECGs by pediatric cardiologists may significantly reduce underdetection of clinically important ECG findings in children.
Related Concept Videos
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and the T...
01:24ECG Interpretation of Rhythms
Components of the Electrocardiogram
The primary components of a normal ECG waveform in Normal sinus rhythm(NSR) include the P wave, PR interval, QRS complex, ST segment, T wave, and occasionally a U wave.
ECG waveforms are divided by vertical and horizontal lines at standard intervals.
The horizontal axis measures time and rate, and the vertical axis measures amplitude or voltage. When...
01:28Electrocardiogram Fundamentals
An electrocardiogram (ECG) is a diagnostic tool for identifying cardiac conditions such as arrhythmias, conduction abnormalities, and myocardial ischemia.
Definition
An electrocardiogram (ECG) visualizes the heart's electrical activity by tracing the electrical movement associated with each heartbeat on a graph or monitor. As the heart beats, an electrical wave passes through it, correlating with the cardiac cycle events.
Parts of an ECG
An ECG utilizes electrodes on the skin to...
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:16ECG Interpretation of Arrhythmias I: Sinus Arrhythmias
Types of Arrhythmias
Sinus Node Arrhythmias
Sinus Bradycardia: Originating from the sinoatrial (SA) node, sinus bradycardia involves slower impulses, resulting in a heart rate of less than 60 beats per minute (bpm). Causes include sleep, vagal stimulation, beta-blockers, hypothyroidism, and...
01:30Dysrhythmias V: Evaluating Dysrhythmias