Use of An Abbreviated Electrocardiogram in Pediatrics: It is Time for a Change!

Abstract

Introduction Alternate electrocardiogram (ECG) acquisition with fewer than 12 leads has not been systematically evaluated in pediatric patients. This study aimed to determine if an abbreviated ECG with fewer leads maintained diagnostic accuracy in pediatric ECGs. Methods Single center, systematic review of randomly selected standard 12-lead ECGs from our hospital database (2017–2020) was performed. Utilizing an overlay technique, 8-(limb + V1/V6) and 6-lead (limb only) variations of 12-lead tracings were generated and interpreted by two independent pediatric electrophysiologists. Results 600 pediatric ECGs were generated from 200 patients (age range 2 weeks-21 years old). There was high percent agreement (92.5–100%) amongst the readers. When comparing 12-lead to 6- and 8-lead ECGs, there was almost perfect agreement in rhythm identification (97.5–100%, 𝜅 0.85-1) and substantial agreement with specific interval measurements (97.5–100%, k 0.66-1). The 8-lead showed substantial agreement with 12-lead ECGs when identifying specific ECG patterns (97.5–100%, 𝜅 0.66-1). A similar degree of agreement was not seen with the 6-lead variant. Utilizing the 12-lead ECG as the gold standard, sensitivity and specificity of the 8- and 6-lead ECG were > 89% for rhythm identification. The specificity for interval measurements and pattern recognition was > 99% while sensitivity was reduced for both 6- and 8- lead ECG, likely due to smaller sample size and fewer abnormal ECGs. Conclusions An 8-lead ECG provided comparable diagnostic accuracy to a 12-lead ECG for rhythm identification, interval measurement, and ECG pattern recognition. This information can be integrated into future technological advancements in ECG acquisition tailored specifically for pediatrics.