Utilization of the electrocardiogram in the pediatric emergency department
Carly Theiler1, Joseph Arms2, Gretchen Cutler2
1Children's Minnesota, Minneapolis, MN, USA; University of Iowa, Department of Emergency Medicine, IA, USA.
Insights
Clinically significant pediatric electrocardiogram (ECG) results are rare, with only 12.7% of tests showing abnormalities requiring follow-up. Young age, male sex, and specific indications like arrhythmia increase the risk of significant findings.
Area of Science:
- Pediatric Cardiology
- Emergency Medicine
- Clinical Diagnostics
Background:
- Electrocardiogram (ECG) is a crucial diagnostic tool in pediatric emergency departments (PEDs).
- Understanding the classification and prevalence of clinically significant ECG results is essential for appropriate patient management.
- Previous studies have not comprehensively reviewed ECG utilization and result severity in the pediatric population.
Purpose of the Study:
- To classify the severity of pediatric electrocardiogram (ECG) results.
- To determine the utilization rates of ECG testing in a pediatric emergency department (PED).
- To establish the frequency of clinically significant ECG results in pediatric patients.
Main Methods:
- Retrospective review of 16,147 pediatric ECGs performed in a tertiary children's hospital PED from 2005-2017.
- ECG results were categorized into four classes (0-III) based on established guidelines and expert consultation, defining clinical significance.
- Statistical analyses, including chi-square tests and multivariable regression, were used to identify factors associated with clinically significant results.
Main Results:
- Chest pain and syncope were the most common indications for ECGs, accounting for over half of all tests.
- Overall, 12.7% of pediatric ECGs yielded clinically significant results (Class II/III), with only 2.0% classified as severe (Class III).
- Factors associated with increased odds of clinically significant ECGs included younger age (≤1 year), male sex, and indications such as arrhythmia, cardiac issues, or electrolyte abnormalities.
Conclusions:
- Clinically significant ECG abnormalities are infrequent in the pediatric population presenting to the emergency department.
- The majority of pediatric ECGs reveal normal or mildly abnormal results, rarely requiring immediate intervention.
- Identifying specific patient demographics and clinical indications can help predict the likelihood of significant ECG findings in children.
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.
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