Wathen Joe E, Rewers Arleta B, Yetman Anji T, Schaffer Michael S
Division of Emergency Medicine, Department of Pediatrics, University of Colorado, Denver and Health Sciences Center/The Children's Hospital, Denver, CO, USA.
Ann Emerg Med. 2005 Dec;46(6):507-11. doi: 10.1016/j.annemergmed.2005.03.013. Epub 2005 Jun 13.
We assess accuracy of ECG interpretation and indications for obtaining ECGs and develop a clinical classification system of ECG abnormalities.
Prospectively acquired ECG data on patients 0 to 21 years of age and presenting to our pediatric emergency department (ED) were obtained. Clinical indications were documented. The initial ECG interpretation (pediatric ED attending physician) was compared with the criterion standard (pediatric cardiologist). A blinded cardiology panel reviewed discrepancies, and a final concordance rate was determined. An ECG abnormality classification system was developed and used to categorize these abnormal ECGs.
One thousand six hundred fifty-three ECGs from 1,501 patients, aged 2 days to 21 years (median 10.0 years), were obtained during 3.5 years. Fifty-one percent were male patients. ECG indications included chest pain (21%), seizure or syncope (18%), arrhythmias (17%), apparent life-threatening event or respiratory symptoms (16%), ingestions (10%), cardiac abnormality (10%), and miscellaneous (8%). From 1,631 ECGs, 1,160 (71%) were normal (class 0), 259 (16%) were minimally abnormal (class I), 174 (11%) were moderately abnormal (class II), and 38 (2%) were severely abnormal (class III). Kendall's tau-b test showed concordance of 0.73 (95% confidence interval 0.70 to 0.77) between pediatric ED and cardiology interpretation. The sensitivity of pediatric ED interpretation was 75%, and the specificity was 98.5%. The positive predictive value of pediatric ED interpretation was 88.3%, and the negative predictive value was 96.3%.
We conclude that, overall, a high rate of concordance exists between the pediatric emergency physician's and the cardiologist's ECG interpretation. The majority of discordant ECGs are not clinically significant. However, among the clinically significant ECGs, there is a higher rate of discordance. These data suggest that review of pediatric ECGs by pediatric cardiologists may significantly reduce underdetection of clinically important ECG findings in children.
我们评估心电图解读的准确性、获取心电图的指征，并制定心电图异常的临床分类系统。
获取前瞻性收集的0至21岁就诊于我院儿科急诊科（ED）患者的心电图数据。记录临床指征。将初始心电图解读（儿科急诊科主治医师）与标准对照（儿科心脏病专家）进行比较。一个不知情的心脏病学小组审查差异，并确定最终的一致率。制定了一个心电图异常分类系统，并用于对这些异常心电图进行分类。
在3.5年期间，获取了1501例年龄在2天至21岁（中位数10.0岁）患者的1653份心电图。51%为男性患者。心电图指征包括胸痛（21%）、癫痫或晕厥（18%）、心律失常（17%）、明显危及生命事件或呼吸道症状（16%）、摄入（10%）、心脏异常（10%）和其他（8%）。在1631份心电图中，1160份（71%）正常（0级），259份（16%）轻度异常（I级），174份（11%）中度异常（II级），38份（2%）重度异常（III级）。Kendall's tau-b检验显示儿科急诊科与心脏病学解读之间的一致性为0.73（95%置信区间0.70至0.77）。儿科急诊科解读的敏感性为75%，特异性为98.5%。儿科急诊科解读的阳性预测值为88.3%，阴性预测值为96.3%。
我们得出结论，总体而言，儿科急诊医师和心脏病专家对心电图的解读一致性较高。大多数不一致的心电图在临床上无显著意义。然而，在具有临床意义的心电图中，不一致率较高。这些数据表明，儿科心脏病专家对儿科心电图的审查可能会显著减少儿童临床重要心电图发现的漏诊。
