USE OF THE ELECTROCARDIOGRAM IN A PEDIATRIC EMERGENCY DEPARTMENT

Objective: To ascertain the quality of electrocardiogram (ECG) use in a pediatric emergency department (PED). Research Design: Patient serie s. Setting: Pediatric emergency department in a university-based hospi tal. Participants: Seventy patients, aged 2 months to 22 years. Measur ements: All ECGs obtained in the PED were received by the Division of Pediatric Cardiology during the 15-month study period. The charts of a ll patients were then reviewed to determine the (1) indications for ob taining an ECG; (2) accuracy of documentation; (3) impact of ECG resul ts on the treatment of patients; and (4) concordance between PED and p ediatric cardiologists in ECG interpretation. Results: Chest pain was the most commonly documented indication, accounting for 54% of the ECG s obtained. Other indications were suspected arrhythmias (11%), seizur e and syncope (11%), drug exposure (8%), and miscellaneous (16%). Twel ve charts (17%) lacked documentation of ECG results. Ten ECGs (14%) we re performed improperly. Twenty three (32%) were interpreted different ly by the pediatric cardiologists; 14 ECGs (20%) had potential clinica l relevance. Thirty-seven (52%) ECGs were useful in patient care; this was significantly associated with the presence of a PED attending (P= .03 by Fisher's Exact Test). Conclusion: We recommend education of ped iatric residents in ECG interpretation and subsequent review by a pedi atric cardiologist of each ECG performed in the PED.