Colombo Jamie N, Samson Ricardo A, Valdes Santiago O, Meziab Omar, Sisk David, Klewer Scott E
1Department of Pediatrics,University of Arizona,Tucson,Arizona,United States of America.
2Department of Pediatric Cardiology,University of Arizona,Tucson,Arizona,United States of America.
Cardiol Young. 2017 Apr;27(3):512-517. doi: 10.1017/S104795111600086X. Epub 2016 Jun 20.
Sudden cardiac arrest is a rare but devastating cause of death in young adults. Electrocardiograms may detect many causes of sudden cardiac arrest, but are not routinely included in pre-athletic screening in the United States of America partly because of high rates of false-positive interpretation. To improve electrocardiogram specificity for identifying cardiac conditions associated with sudden cardiac arrest, an expert panel developed refined criteria known as the Seattle Criteria. Ours is the first study to compare standard electrocardiogram criteria with Seattle Criteria in 11- to 13-year-olds. In total, 1424 students completed the pre-athletic screening and electrocardiogram; those with a positive screen or abnormal electrocardiogram interpreted by a paediatric electrophysiologist completed further work-up. Electrocardiograms referred for additional evaluation were re-interpreted by a paediatric electrophysiologist using Seattle Criteria. Electrocardiogram abnormalities were identified in 98 (6.9%); Seattle Criteria identified 28 (2.0%). Formal evaluation confirmed four students at risk for sudden cardiac arrest (0.3%): long QT syndrome (n=2), Wolff-Parkinson-White (n=1), and pulmonary hypertension (n=1). All students with at-risk phenotypes for sudden cardiac arrest were identified by both standard electrophysiologist and Seattle Criteria. The false-positive interpretation rate decreased from 6.6 to 1.7% with Seattle Criteria. Downstream costs associated with screening using standard paediatric electrocardiogram interpretations and Seattle Criteria were projected at $24 versus $7, respectively. In conclusion, using Seattle Criteria for electrocardiogram interpretation decreases the rate of false-positive results compared with standard interpretation without omitting true-positive electrocardiogram findings. This may decrease unnecessary referrals and costs associated with formal cardiology evaluation.
心脏骤停是年轻成年人中一种罕见但极具毁灭性的死因。心电图可能检测出许多导致心脏骤停的原因，但在美国的运动前筛查中通常不包括心电图，部分原因是假阳性解读率较高。为提高心电图识别与心脏骤停相关心脏疾病的特异性，一个专家小组制定了被称为西雅图标准的细化标准。我们的研究是第一项在11至13岁儿童中比较标准心电图标准与西雅图标准的研究。共有1424名学生完成了运动前筛查和心电图检查；筛查呈阳性或儿科电生理学家解读为心电图异常的学生完成了进一步检查。被转介进行额外评估的心电图由儿科电生理学家使用西雅图标准重新解读。98例（6.9%）心电图出现异常；西雅图标准识别出28例（2.0%）。正式评估确认4名学生有心脏骤停风险（0.3%）：长QT综合征（n = 2）、预激综合征（n = 1）和肺动脉高压（n = 1）。所有有心脏骤停风险表型的学生均被标准电生理学家和西雅图标准识别出来。使用西雅图标准后，假阳性解读率从6.6%降至1.7%。使用标准儿科心电图解读和西雅图标准进行筛查的下游成本预计分别为24美元和7美元。总之，与标准解读相比，使用西雅图标准解读心电图可降低假阳性结果率，同时不遗漏真正的阳性心电图结果。这可能会减少不必要的转诊以及与正式心脏科评估相关的成本。
