Sensitivity and specificity of an automated external defibrillator algorithm designed for pediatric patients.
OBJECTIVE
Electrocardiographic (ECG) rhythm analysis algorithms for cardiac rhythm analysis in automated external defibrillators (AEDs) have been tested against pediatric patient rhythms (patients < or = 8 years old) using adult ECG algorithm criteria. However these adult algorithms may fail to detect non-shockable pediatric tachycardias because they do not account for the difference in the rates of normal sinus rhythm and typical tachyarrhythmias in childhood.


METHODS
This study was designed to define shockable and non-shockable rhythm detection criteria specific to pediatric patients to create a pediatric rhythm database of annotated rhythms, to develop a pediatric-based AED rhythm analysis algorithm, and to test the algorithm's accuracy. Pediatric rhythm detection criteria were defined for coarse ventricular fibrillation, rapid ventricular tachycardia, and non-shockable rhythms, including pediatric supraventricular tachycardia. Pediatric rhythms were collected as sustained, classifiable, rhythms > or = 9 s in length, and were annotated by pediatric electrophysiologists as clinically shockable or non-shockable based on pediatric criteria. Rhythms were placed into a pediatric rhythm database; each rhythm was converted to digitally accessible, public-domain, MIT rhythm data format. The database was used to evaluate a pediatric-based AED rhythm analysis algorithm.


RESULTS
Electrocardiographic rhythms from 198 children were recorded. There were 120 shockable rhythms from 49 patients (sensitivity; coarse ventricular fibrillation: 42 rhythms, 100%; rapid ventricular tachycardia: 78 rhythms, 94%), for combined sensitivity of 96.0% (115/120). There were 585 non-shockable rhythms from 155 patients (specificity normal sinus: 208 rhythms, 100%; asystole: 29 rhythms, 100%; supraventricular tachycardia: 161 rhythms, 99%; other arrhythmias: 187 rhythms, 100%), for combined specificity of 99.7% (583/585). Overall accuracy for shockable and non-shockable rhythms was 99.0% (702/709).


CONCLUSIONS
New pediatric rhythm detection criteria were defined and analysis based on these criteria demonstrated both high sensitivity (coarse ventricular fibrillation, rapid ventricular tachycardia) and high specificity (non-shockable rhythms, including supraventricular tachycardia). A pediatric-based AED can detect shockable rhythms correctly, making it safe and exceptionally effective for children.
Atkins
Dianne L
DL
Division of Pediatric Cardiology, University of Iowa, 200 Hawkins Drive, University of Iowa Children's Hospital, Iowa City, IA 52242, United States. dianne-atkins@uiowa.edu
Scott
William A
WA
Blaufox
Andrew D
AD
Law
Ian H
IH
Dick
Macdonald
M
Geheb
Frederick
F
Sobh
Jamil
J
Brewer
James E
JE
D000328:Adult; D000465:Algorithms; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D047548:Defibrillators / Q000592:standards*; D004554:Electric Countershock / Q000295:instrumentation*; D004562:Electrocardiography; D004867:Equipment Design; D006323:Heart Arrest / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007223:Infant; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity