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 series. SETTING: Pediatric emergency department in a university-based hospital. PARTICIPANTS: Seventy patients, aged 2 months to 22 years. MEASUREMENTS: All ECGs obtained in the PED were received by the Division of Pediatric Cardiology during the 15-month study period. The charts of all patients were then reviewed to determine the (1) indications for obtaining an ECG; (2) accuracy of documentation; (3) impact of ECG results on the treatment of patients; and (4) concordance between PED and pediatric cardiologists in ECG interpretation. RESULTS: Chest pain was the most commonly documented indication, accounting for 54% of the ECGs obtained. Other indications were suspected arrhythmias (11%), seizure and syncope (11%), drug exposure (8%), and miscellaneous (16%). Twelve charts (17%) lacked documentation of ECG results. Ten ECGs (14%) were performed improperly. Twenty three (32%) were interpreted differently by the pediatric cardiologists; 14 ECGs (20%) had potential clinical 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 pediatric residents in ECG interpretation and subsequent review by a pediatric cardiologist of each ECG performed in the PED.