title: Electrocardiogram interpretation by Canadian general paediatricians: Examining practice, accuracy and confidence.
abstract: BACKGROUND
  Paediatric electrocardiograms (ECGs) are ordered and interpreted by general paediatricians; however, no previous studies have evaluated the accuracy of their ECG interpretations.
  
  
  OBJECTIVE
  To determine general paediatricians' practice and opinions regarding ECG use, accuracy of their interpretation of paediatric ECGs, and the relationship between accuracy and self-perceived confidence.
  
  
  METHODS
  In the present cross-sectional study, Canadian general paediatricians were asked to complete a questionnaire and interpret 18 paediatric ECGs. The questionnaire assessed characteristics of ECG use, self-perceived confidence and opinions regarding ECG use in general paediatric practice. For the ECGs provided, respondents were asked whether the ECG was normal or abnormal, what abnormality the ECG demonstrated and how confident they were in this interpretation.
  
  
  RESULTS
  ECG interpretation was performed by 124 general paediatricians. General paediatricians frequently use ECGs in their practice and regard this investigation as useful in patient assessment. The mean (± SD) accuracy of identifying ECGs as normal or abnormal, and identifying the specific abnormality was 80±12% and 56±20%, respectively. The sensitivity and specificity of identifying abnormal ECGs were 80% (95% CI 78% to 82%) and 79% (95% CI 75% to 83%), respectively. Correct ECG interpretation for isolated rhythm disturbances (73%) was significantly better than for abnormalities in axis (25%), chamber hypertrophy (41%) and ECG intervals (49%) (P<0.001). Overall confidence in ECG interpretation correlated with and was the only significant predictor of interpretation accuracy (r=0.396, P<0.001).
  
  
  CONCLUSIONS
  General paediatricians were adept at detecting abnormal ECGs, but were less able to identify the abnormalities. Further education in ECG interpretation may be important for this population.
authors.affiliation: British Columbia Children's Hospital, Vancouver, British Columbia;
authors.forename: Carolina A
authors.initials: CA
authors.lastname: Escudero
authors.affiliation: British Columbia Children's Hospital, Vancouver, British Columbia;
authors.forename: Shubhayan
authors.initials: S
authors.lastname: Sanatani
authors.affiliation: IWK Health Centre, Halifax, Nova Scotia;
authors.forename: Kenny K
authors.initials: KK
authors.lastname: Wong
authors.affiliation: Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland and Labrador.
authors.forename: Christina G
authors.initials: CG
authors.lastname: Templeton
keywords: Clinical competence; Electrocardiography; Medical education; Paediatrics; Physicians’ practice patterns; Questionnaires