1060 Tackling child inequality in a UK Emergency Department: a pilot early intervention service on the shop floor

Abstract

Aims According to NICE guidelines, a 12-lead electrocardiogram (ECG) should be obtained as part of the assessment of any > 16-year-olds who present with transient loss of consciousness. Although there are no formal guidelines in place from NICE regarding the approach to < 16-year-old children, the >16 guideline has been extrapolated to the younger population and that ECG should be performed for all patients who present with transient loss of consciousness. It is rare to have fainting caused by heart issues during childhood; however, it causes most concern as cardiac causes can be life-threatening.Cardiac causes of syncope can be due to blockage of blood flow (e.g. aortic stenosis, hypertrophic cardiomyopathy), abnormal heart rhythms (ventricular tachycardia, Wolff-Parkinson-White syndrome, long QT syndrome, sinus node dysfunction, atrioventricular block, and catecholaminergic polymorphic VT), and reduced heart function (e.g. dilated cardiomyopathy, acute myocarditis, ischaemic heart disease secondary to anomalous coronary artery). A 12-lead ECG is a helpful aid for the clinician to rule out any cardiac causes of transient loss of consciousness.We aim to elucidate if ECGs were performed for paediatric patients who present to the Emergency Department with syncope, cyanosis, murmurs, chest pain and transient loss of consciousness across a 4 week period Methods Electronic data and patient records were retrospectively reviewed for patients who attended the Paediatric Emergency Department with transient loss of consciousness over a period of 4 weeks. Patients who are coded as LOC, loss of consciousness, vasovagal, syncope, blackout, seizure, collapse were included in the search. Anonymised data were collected on an Excel spreadsheet and analysed using GraphPad Prism and SPSS, using appropriate statistical tests. Results 34 ECGs were requested across the data collection period. 26% (9/36) of ECGs performed were not documented. 18% (6/36) of patients who had ECGs performed and reviewed required inpatient cardiac intervention or outpatient follow up and further investigations. Notably, a patient who presented with poor feeding and cyanosis with an underlying diagnosis of ALCAPA (Anomalous Left Coronary Artery from the Pulmonary Artery) Syndrome with severe left ventricular dysfunction did not have their ECG findings documented. Conclusion The number of ECGs performed for children presenting to a Children's Emergency Department is small, but a significant proportion of them is not documented. This could have medicolegal implications. We highlight that a major barrier to ECG documentation is due to inexperience in ECG interpretation, and additional local training could help address this.