Pediatric Emergency Department Study of Cardiac Risk in the Novel Patient (PED SCReeN)

Timothy Horeczko, Jeanny K Park, Courtney Mann, Angelo Milazzo

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

OBJECTIVE: We compare pediatric cardiac risk classification and management recommendations between emergency physicians (EPs) and pediatric cardiologists (PCs) in children with a suspected new cardiac disorder. METHODS: We prospectively compared the work-up, assessment, classification, and disposition of patients aged 0 to 21 years presenting to the emergency department with a potential cardiac etiology in whom an electrocardiogram (ECG) was performed. The criterion standard was a blinded assessment by the PC-electrophysiologist after review of the history, physical examination, ancillary tests, and ECG. RESULTS: In 508 subjects, the median age was 15 years (interquartile range, 11–17 years), with a slight female predominance (281, 55.3%). The most common reasons for obtaining an ECG were: chest pain (158, 31.1%) and syncope, presyncope, or possible seizure (146, 28.7%). The most common auxiliary study was a chest radiograph (432, 85% of subjects). A total of 617 electrocardiographic diagnoses were made by EPs and 984 diagnoses by PCs. Sensitivities and specificities varied by discrete class, but disposition decisions were concordant (home or admission). The EPs were highly accurate for the need for emergent cardiology involvement (area under the curve, 0.89). CONCLUSIONS: The EPs and PCs agreed on the evaluation and disposition of children at either low risk or high risk for an acute cardiac presentation in the emergency department. There was considerable variation in management recommendations in the intermediate risk children needing cardiology outpatient follow-up. We recommend the development and implementation of focused training modules on emergency pediatric cardiology and increased communication with pediatric cardiology to improve patient safety and resource utilization.

Original languageEnglish (US)
JournalPediatric Emergency Care
DOIs
StateAccepted/In press - Mar 3 2016

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Hospital Emergency Service
Pediatrics
Cardiology
Emergencies
Physicians
Electrocardiography
Syncope
Risk Management
Patient Safety
Chest Pain
Physical Examination
Area Under Curve
Seizures
Outpatients
Thorax
History
Communication
Sensitivity and Specificity
Cardiologists

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine

Cite this

Pediatric Emergency Department Study of Cardiac Risk in the Novel Patient (PED SCReeN). / Horeczko, Timothy; Park, Jeanny K; Mann, Courtney; Milazzo, Angelo.

In: Pediatric Emergency Care, 03.03.2016.

Research output: Contribution to journalArticle

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