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Predictors of abnormal electrocardiograms in the pediatric emergency department
Shiv Gandhi1, Miranda Lin1, Sharon R Smith2
1Department of Pediatrics, University of Connecticut, Storrs, CT, USA.
Insights
Pediatric emergency electrocardiograms (ECGs) are often normal in children with chest pain or respiratory conditions and normal vital signs. This finding helps guide clinicians on ECG use in the pediatric emergency department.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Cardiology
- Diagnostic Electrocardiography
Background:
- Electrocardiograms (ECGs) are frequently utilized in pediatric emergency settings for diverse patient complaints.
- Clear criteria for ordering ECGs in children are currently limited.
- This study addresses the need for objective guidelines in pediatric ECG interpretation.
Purpose of the Study:
- To identify objective criteria for predicting abnormal electrocardiograms (ECGs) in pediatric emergency department (ED) patients.
- To guide clinicians on appropriate ECG utilization based on patient history and vital signs.
- To analyze factors associated with abnormal ECG findings in a large pediatric cohort.
Main Methods:
- Retrospective chart review of 880 pediatric patients (<18 years) who underwent ECG in the ED.
- Collected data included physician ECG interpretations, vital signs, and past medical history.
- Logistic regression analysis was employed to identify predictors of abnormal ECGs.
Main Results:
- 17.4% of all performed ECGs in the pediatric ED were abnormal.
- Abnormal ECGs were associated with age-adjusted abnormal vital signs, specifically increased heart rate (OR 1.85) and respiratory rate (OR 1.74).
- Chief complaints of chest pain (OR 0.38) and a history of respiratory conditions like asthma (OR 0.48) were associated with a lower likelihood of abnormal ECGs.
Conclusions:
- Children presenting to the pediatric ED with chest pain or known respiratory conditions and normal vital signs have a low probability of an abnormal ECG.
- These findings can help refine clinical decision-making regarding ECG orders in pediatric emergency care.
- Objective criteria derived from vital signs and medical history can aid in judicious ECG use.
Background:
Electrocardiograms (ECGs) are ordered in the pediatric emergency room for a wide variety of chief complaints.
Objectives:
Criteria are lacking as to when physicians should obtain ECGs. This study uses a large retrospective cohort of 880 pediatric emergency department (ED) patients to highlight objective criteria including significant medical history and specific vital sign abnormalities to guide clinicians as to which patients might have an abnormal ECG.
Methods:
Retrospective review of Pediatric ED charts in all patients aged < 18 years who had ECG performed during ED stay. Pediatric ED physician interpretation of the ECG, clinical data on vital signs and past medical history was collected from the medical record for analysis.
Results:
Of 880 ECGs performed in the ED, 17.4% were abnormal. When controlled for medical history and demographic differences, abnormal ECGs were associated with age-adjusted abnormal ED vital signs including increased heart rate (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.1-3.09) and increased respiratory rate (OR 1.74, CI 1.42-2.62). In a logistic regression analysis, certain chief complaints and history components were less likely to have abnormal ECGs including complaints of chest pain (OR 0.38, CI 0.18-0.80) and known history of gastrointestinal or respiratory condition (i.e., asthma) (OR 0.48, CI 0.29-0.79).
Conclusions:
In this cohort of patients, those with a chief complaint of chest pain or known respiratory conditions and normal age-adjusted vital signs in the ED have low likelihood of an abnormal ECG.
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