Use of the electrocardiogram in a pediatric emergency department.
OBJECTIVE
To ascertain the quality of electrocardiogram (ECG) use in a pediatric emergency department (PED).


METHODS
Patient series.


METHODS
Pediatric emergency department in a university-based hospital.


METHODS
Seventy patients, aged 2 months to 22 years.


METHODS
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).


CONCLUSIONS
We recommend education of pediatric residents in ECG interpretation and subsequent review by a pediatric cardiologist of each ECG performed in the PED.
Horton
L A
LA
Department of Pediatrics, University of Maryland School of Medicine, Baltimore.
Mosee
S
S
Brenner
J
J
D001145:Arrhythmias, Cardiac / Q000175:diagnosis; D016507:Cardiology Service, Hospital; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology; D002637:Chest Pain / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D003658:Decision Making, Computer-Assisted; D004562:Electrocardiography / Q000592:standards* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010372:Pediatrics; D012640:Seizures / Q000175:diagnosis; D019966:Substance-Related Disorders / Q000150:complications; D013575:Syncope / Q000175:diagnosis