Specificity and sensitivity of automated external defibrillator rhythm analysis in infants and children.
OBJECTIVE
The rhythm detection algorithms of automated external defibrillators have been derived from adult rhythms, and their ability to discriminate between shockable and nonshockable rhythms in children is largely unknown. This study evaluates the performance of 1 automated external defibrillator algorithm in infants and children and evaluates algorithm performance with anterior-posterior versus sternal-apex lead placement.


METHODS
We enrolled pediatric patients in a critical care unit, an electrophysiology laboratory, and a cardiac operating room. A monitor-defibrillator recorded ECGs by means of standard defibrillation-monitor pads. Selected 15-second rhythm samples were played into a LIFEPAK 500 automated external defibrillator, and the automated external defibrillator "shock/no shock" decision was documented. To determine sensitivity and specificity, the automated external defibrillator decision was compared with the "shockable" versus "nonshockable" rhythm classification provided by 3 expert clinicians who were blinded to the automated external defibrillator decision.


RESULTS
We recorded 1,561 rhythm samples from 203 pediatric patients (median age 11 months; range, day of birth to 7 years). The automated external defibrillator recommended a shock for 72 of 73 rhythm samples classified as coarse ventricular fibrillation by expert review (sensitivity 99%; 95% confidence interval [CI] 93% to 100%); and correctly reached a "no shock advised" decision for 1,465 of 1,472 rhythm samples classified as nonshockable by experts (specificity 99.5%). Specificity was 99.1% (95% CI 97.8% to 99.8%) with the sternal-apex lead and 99.4% (95% CI 98.1% to 99.9%) with the anterior-posterior lead.


CONCLUSIONS
This automated external defibrillator algorithm has high specificity and sensitivity when used in infants and children with either sternal-apex or anterior-posterior lead placement.
Atkinson
Elizabeth
E
Department of Emergency Medicine, Indiana University, Indianapolis, IN, USA.
Mikysa
Bridget
B
Conway
Jeffrey A
JA
Parker
Morgan
M
Christian
Karla
K
Deshpande
Jayant
J
Knilans
Timothy Kevin
TK
Smith
Jacqueline
J
Walker
Carolyn
C
Stickney
Ronald E
RE
Hampton
David R
DR
Hazinski
Mary Fran
MF
D000367:Age Factors; D000465:Algorithms; D001331:Automation; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D003658:Decision Making, Computer-Assisted; D003661:Decision Support Techniques; D003936:Diagnosis, Computer-Assisted / Q000592:standards*; D016002:Discriminant Analysis; D004554:Electric Countershock / Q000295:instrumentation* / Q000592:standards*; D004562:Electrocardiography / Q000295:instrumentation* / Q000592:standards*; D004566:Electrodes; D004632:Emergency Medical Services; D006339:Heart Rate; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000592:standards*; D011674:Pulse; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D014693:Ventricular Fibrillation / Q000145:classification / Q000175:diagnosis* / Q000628:therapy