Electrocardiogram interpretation by Canadian general paediatricians: Examining practice, accuracy and confidence.

Abstract:

BACKGROUND:Paediatric electrocardiograms (ECGs) are ordered and interpreted by general paediatricians; however, no previous studies have evaluated the accuracy of their ECG interpretations. OBJECTIVE:To determine general paediatricians' practice and opinions regarding ECG use, accuracy of their interpretation of paediatric ECGs, and the relationship between accuracy and self-perceived confidence. METHODS:In the present cross-sectional study, Canadian general paediatricians were asked to complete a questionnaire and interpret 18 paediatric ECGs. The questionnaire assessed characteristics of ECG use, self-perceived confidence and opinions regarding ECG use in general paediatric practice. For the ECGs provided, respondents were asked whether the ECG was normal or abnormal, what abnormality the ECG demonstrated and how confident they were in this interpretation. RESULTS:ECG interpretation was performed by 124 general paediatricians. General paediatricians frequently use ECGs in their practice and regard this investigation as useful in patient assessment. The mean (± SD) accuracy of identifying ECGs as normal or abnormal, and identifying the specific abnormality was 80±12% and 56±20%, respectively. The sensitivity and specificity of identifying abnormal ECGs were 80% (95% CI 78% to 82%) and 79% (95% CI 75% to 83%), respectively. Correct ECG interpretation for isolated rhythm disturbances (73%) was significantly better than for abnormalities in axis (25%), chamber hypertrophy (41%) and ECG intervals (49%) (P<0.001). Overall confidence in ECG interpretation correlated with and was the only significant predictor of interpretation accuracy (r=0.396, P<0.001). CONCLUSION:General paediatricians were adept at detecting abnormal ECGs, but were less able to identify the abnormalities. Further education in ECG interpretation may be important for this population. HISTORIQUE:Ce sont des pédiatres généralistes qui demandent et interprètent les électrocardiogrammes (ECG) en pédiatrie, mais aucune étude n’a porté sur l’exactitude de leur interprétation. OBJECTIF:Déterminer la pratique et les avis des pédiatres généralistes en matière d’utilisation des ECG et de l’exactitude des ECG en pédiatrie et établir le lien entre la précision et l’autoperception de la confiance. MÉTHODOLOGIE:Dans la présente étude transversale, les pédiatres généralistes canadiens ont été invités à remplir un questionnaire et à interpréter 18 ECG en pédiatrie. Le questionnaire visait à évaluer les caractéristiques liées à l’utilisation des ECG, l’autoperception de la confiance et les avis relatifs à l’utilisation des ECG en pédiatrie générale. Les répondants étaient invités à préciser si les ECG four-nis étaient normaux ou anormaux, les anomalies démontrées et leur confiance quant à leur interprétation. RÉSULTATS:Cent vingt-quatre pédiatres généralistes ont interprété les ECG. Les pédiatres généralistes utilisent souvent les ECG dans leur pratique et les considèrent comme utiles dans l’évaluation des patients. L’exactitude moyenne dans l’identification des ECG comme normaux ou anormaux et dans la détermination de l’anomalie précise correspondait à 80±12 % et à 56±20 %, respectivement. La sensibilité et la spécificité de l’identification des ECG anormaux s’établissaient à 80 % (95 % IC 78 % à 82 %) et à 79 % (95 % IC 75 % à 83 %), respectivement. La bonne interprétation des ECG révélant des troubles isolés du rythme cardiaque (73 %) était considérablement plus élevée que celle des anomalies de l’axe (25 %), de l’hypertrophie ventriculaire (41 %) et des intervalles d’ECG (49 %) (P<0,001). Dans l’ensemble, la confiance à l’égard de l’interprétation des ECG était corrélée avec l’exactitude des interprétations et en était le seul prédicteur important (r=0,396, P<0,001). CONCLUSION:Les pédiatres généralistes décelaient bien les ECG anormaux, mais réussissaient moins bien à déterminer les anomalies exactes. Il serait peut-être important de leur fournir un perfectionnement dans l’interprétation des ECG.

journal_name

Paediatr Child Health

authors

Escudero CA,Sanatani S,Wong KK,Templeton CG

doi

10.1093/pch/19.2.77

subject

Has Abstract

pub_date

2014-02-01 00:00:00

pages

77-83

issue

2

eissn

1205-7088

issn

1918-1485

journal_volume

19

pub_type

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