O1013: Retrospective Emergency Room EKG Review by Pediatric Cardiologist. Is There an Additional Benefit?

Background: Cardiac abnormalities are important causes of morbidity and mortality in children, affecting ≈35,000 children annually. In the pediatric emergency department (PED), the electrocardiogram (EKG) is an important tool to diagnose emergent cardiac conditions including silent cardiac rhythm disorders. The initial EKG interpretations at PED not only dictate patient care, but also determine the most appropriate disposition and need for follow-up. Therefore, it is important to know the accuracy of the EKG interpretations performed in the PED, as well as recognize common misinterpretations by PED physicians. This study aimed to determine the additional value of having a pediatric cardiologist retrospectively review pediatric EKGs performed in PED.

Methods: We reviewed 316 EKGs from patients ≤ 18 years old without a primary cardiac disease who visited the PED at One Brooklyn Health (OBH) from 01/01/2024 to 02/28/2025 to determine the rates and types of cardiac abnormalities. The discrepancy rate in EKG interpretation between emergency department physicians and a pediatric cardiologist was assessed for potentially clinically significant implications. Categorize variables included EKD diagnosis, cardiac consult and cardiac follow-up were analyzed using multivariable logistic regression by Stata 14.2 software. Significant difference was determined based on p-value < 0.05. All of the EKGs were read by a single pediatric cardiologist.

Results: Of the 316 EKGs, 82.91% were interpreted as normal and 17.09% abnormal by ED physicians, while 46.84% were interpreted as abnormal and 53.16% normal by the pediatric cardiologist. Among 53.16% patients with an abnormal EKG read by the pediatric cardiologist, the most common finding was ST/T wave changes. Out of 262 normal EKG read by PED physicians, 44.66% were read as abnormal by the pediatric cardiologist. There was a significant difference between the EKG results read by PED physicians and the pediatric cardiologist (adjusted OR: 25.60, p< 0.001). Of the 117 EKGs read as normal by PED physicians but abnormal by the pediatric cardiologist, 17.95% of the patients had cardiac consult and 10.26% patients had a cardiology appointment as a follow up. Additional tests for further diagnosis and management were recommended for 8.33% patients. Of the 51 EKGs read as abnormal by both PED providers and the pediatric cardiologist, 21.57% of the patients were referred for cardiac consultation. Of these 21.57% patients, 45.45% were admitted to the hospital for further evaluation and management.

Conclusion: There is a significant difference in EKG interpretation between PED physicians and the pediatric cardiologist. Therefore, it is important to have a pediatric cardiologist retrospectively reviews the emergency department EKGs to prevent misinterpretation and potentially avoiding adversely affected patient care. Although these are preliminary findings from a single hospital. If these findings are replicated in other centers, it may indicate that PED fellows would benefit from additional experience in interpreting EKGs.