• Timothy Horeczko, Jeanny K Park, Courtney Mann, and Angelo Milazzo.
• From the *Department of Emergency Medicine, Harbor-UCLA Medical Center and the Los Angeles Biomedical Research Institute, Torrance; †Division of Cardiology, Department of Pediatrics, University of California, Davis Medical Center, Sacramento, CA; ‡Department of Emergency Medicine, University of North Carolina, WakeMed Raleigh Campus, Raleigh; and §Division of Cardiology, Department of Pediatrics, Duke University, Durham, NC.
• Pediatr Emerg Care. 2017 Oct 1; 33 (10): e79-e86.

ObjectiveWe compare pediatric cardiac risk classification and management recommendations between emergency physicians (EPs) and pediatric cardiologists (PCs) in children with a suspected new cardiac disorder.MethodsWe 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.ResultsIn 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).ConclusionsThe 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.

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