Department of Pediatrics, Stanford University, Stanford, CA, USA.
J Pediatr. 2011 Nov;159(5):783-8. doi: 10.1016/j.jpeds.2011.05.014. Epub 2011 Jul 14.
To evaluate the accuracy of pediatric cardiologists' interpretations of electrocardiograms (ECGs).
A series of 18 ECGs that represented conditions causing pediatric sudden cardiac death or normal hearts were interpreted by 53 members of the Western Society of Pediatric Cardiology. Gold-standard diagnoses and recommendations were determined by 2 electrophysiologists (100% concordance).
The average number of correct ECG interpretations per respondent was 12.4 ± 2.2 (69%, range 34%-98%). Respondents achieved a sensitivity of 68% and a specificity of 70% for recognition of any abnormality. The false-positive and false-negative rates were 30% and 32%, respectively. Based on actual ECG diagnosis, sports participation was accurately permitted in 74% of cases and accurately restricted in 81% of cases. Respondents gave correct sports guidance most commonly in cases of long QT syndrome and myocarditis (98% and 90%, respectively) and least commonly in cases of hypertrophic cardiomyopathy, Wolff-Parkinson-White syndrome, and pulmonary hypertension (80%, 64%, and 38%, respectively). Respondents ordered more follow-up tests than did experts.
Preparticipation screening ECGs are difficult to interpret. Mistakes in ECG interpretation could lead to high rates of inappropriate sports guidance. A consequence of diagnostic error is overuse of ancillary diagnostic tests.
评估儿科心脏病专家解读心电图（ECG）的准确性。
本系列研究包含了 18 份心电图，代表了引起儿科心源性猝死或正常心脏的情况。由 53 名西方儿科心脏病学会成员进行解释。通过 2 位电生理学家（100%一致性）确定金标准诊断和建议。
每位受访者平均正确解读的心电图数量为 12.4±2.2（69%，范围 34%-98%）。受访者对任何异常的识别灵敏度为 68%，特异性为 70%。假阳性和假阴性率分别为 30%和 32%。根据实际的心电图诊断，74%的情况下可以准确地允许参加运动，81%的情况下可以准确地限制运动。受访者在长 QT 综合征和心肌炎的情况下最常给出正确的运动指导（98%和 90%），而在肥厚型心肌病、WPW 综合征和肺动脉高压的情况下给出正确指导的比例最低（80%、64%和 38%）。受访者比专家更常开出更多的随访检查。
参加运动前的筛查心电图较难解读。心电图解读错误可能导致运动指导不当的高比例。诊断错误的后果是辅助诊断测试的过度使用。
