Article Text

PDF
G346 Paediatric ECG interpretation and documentation in a Children’s Emergency Department – a service evaluation and action plan
  1. P Venugopalan1,
  2. C Bevan2,
  3. S Krishnan1,
  4. H Davies1
  1. 1Paediatrics, Brighton & Sussex University Hospitals, Brighton, UK
  2. 2Children’s Emergency Department, Brighton & Sussex University Hospitals, Brighton, UK

Abstract

Aims To review the practice, usefulness and interpretation of electrocardiogram (ECG) in a Children’s Emergency Department (CED), following a clinical risk incident due to the lack of formal review process of all ECGs in the CED.

Methods All ECGs performed in the CED (25,000 annual attendances) over a 4-month period were analysed retrospectively. Data collected included a) patient data recorded on the ECG printout (name, date of birth, hospital number), b) automatic machine report on the ECG printout, c) interpretation of the ECG by the attending physician, and d) documentation of the results in the case notes.

Results 71 ECGs were performed during the study period. Eight cases were excluded. The 63 patients (M: F 1:1.5) were further analysed. Ages ranged from 21 days to 16 years (mean 10.6yrs). The main indications for the test were chest pain (33%), syncope (32%), seizure or life threatening event (15%), drug overdose (10%) and miscellaneous (10%).

Abstract G346 Table 1

Results of analysis of 63 ECGs performed over a 4-month period in a Children’s Emergency Department (n = 63)

The automatic reporting system on the ECG machine identified 15 (23%) ECGs as showing a prolonged corrected QT interval (QTc). Manual measurement and computation (Bazet’s formula) however, showed all these records have a normal QTc.

There were 9 (2%) abnormal ECGs, which included supraventricular tachycardia (1), left axis deviation (2), left ventricular hypertrophy by voltage criteria (3), left bundle branch block (1), right bundle branch block (1), ST elevation (1).

Conclusion The study showed widespread deficiencies in the performing, interpretation and documentation of ECGs in the CED. A guideline for interpretation of ECG has been introduced and a proforma designed to guide a detailed reporting of all ECGs.

There is now a process for a formal review of all ECGs performed in the department which will prevent any unnecessary cardiology referral and prevent any abnormal ECGs being missed.

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.