title: Preoperative electrocardiograms for nonsyndromic children with hand syndactyly.
abstract: OBJECTIVE
  To examine the efficacy of preoperative electrocardiogram (EKG) screening for Timothy syndrome, a rare and fatal condition characterized by prolonged QT, in children referred for syndactyly release.
  
  
  METHODS
  We reviewed the records of nonsyndromic syndactyly patients seen by a hand surgeon at our institution between 2007 and 2013. All underwent a preoperative screening EKG for Timothy syndrome. We reviewed the medical records for demographics, presentation, EKG results, and operative findings, and calculated median age at the time of EKG and surgery and frequency distributions for sex, side affected, EKG result, and clinical finding. The mean patient charge for EKG and interpretation was calculated.
  
  
  RESULTS
  We identified 128 syndactyly patients, 72% of which were boys. Median age at the time of EKG testing and syndactyly release was 1 year. A total of 92% of patients had normal EKG results; one patient exhibited a prolonged QT. Ten patients (8%) had further cardiac evaluation because of the EKG result and were found to be normal on repeat testing. No patient met QT threshold for Timothy syndrome and all patients were cleared for surgery. The minimum patient charge for EKG testing was $183.
  
  
  CONCLUSIONS
  To improve patient safety, some have advocated preoperative EKG testing for all children undergoing syndactyly release to rule out Timothy syndrome. Analysis of our experience failed to yield an instance of Timothy syndrome over a 7-year period. Although EKG charges were relatively low, costs resulting from additional testing, cardiology consultation, and provider and parent time should be considered. Our study does not support routine EKG testing for children referred for syndactyly release, and we have abandoned this practice.
  
  
  METHODS
  Prognostic IV.
authors.affiliation: Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Nuzzi
authors.affiliation: Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Pike
authors.affiliation: Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Eliza B
authors.initials: EB
authors.lastname: Lewine
authors.affiliation: Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Felecia E
authors.initials: FE
authors.lastname: Cerrato
authors.affiliation: Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Alexander
authors.affiliation: Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Lynne R
authors.initials: LR
authors.lastname: Ferrari
authors.affiliation: Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Donald S
authors.initials: DS
authors.lastname: Bae
authors.affiliation: Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Amir
authors.initials: A
authors.lastname: Taghinia
authors.affiliation: Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Waters
authors.affiliation: Department of Plastic and Oral Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Cardiology, Boston Children's Hospital and Harvard Medical School, Boston, MA; Department of Anesthesiology, Perioperative, and Pain Medicine, Boston Children's Hospital and Harvard Medical School, Boston, MA. Electronic address: brian.labow@childrens.harvard.edu.
authors.forename: Brian I
authors.initials: BI
authors.lastname: Labow
mesh_terms: D001321:Autistic Disorder / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008133:Long QT Syndrome / Q000150:complications / Q000175:diagnosis* / Q000235:genetics; D008297:Male; D061214:Patient Safety; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D013576:Syndactyly / Q000150:complications / Q000175:diagnosis / Q000235:genetics / Q000601:surgery*; D016896:Treatment Outcome
keywords: EKG; pediatric; syndactyly; timothy syndrome