研究显示儿童心电图导联错接率达3%

温哥华——新奥尔良Ochsner医学中心的一项回顾性研究显示，在1,470例小儿心电图(ECG)检查中，导联错接比例为3%。

资深研究员、前Ochsner医学中心小儿心脏病和电生理专家、现就职于凯斯西储大学的Christopher Snyder医生报告称，在发现的45例导联错接病例中，19例为左上肢/左下肢反接，15例为左上肢/右上肢反接，8例为胸前导联错接，3例为右上肢/右下肢反接。大部分错接(31/45)发生在小儿门诊，6例出现在急诊室，8例为住院患者。虽然这些导联错接是由护士和技师操作失误造成的，但小儿电生理医生和其他医生在签发心电图报告时并没发现相关错误。


Christopher Snyder医生
 
Snyder医生认为，出现这一问题的部分原因是，医生们每天必须看大量的ECG，退赔率较低，以及由于大多数儿童ECG没有异常而掉以轻心，因此医生们希望快点签发ECG报告。此外，儿童前胸较小也会导致导联错接，纳入此项研究的儿童平均年龄为10.4岁。

但Snyder医生称，他在1小时20分钟内审阅了上述所有EGC，很容易发现极性反接和其他异常。“我认为我们或许需要3秒钟的时间来解读ECG，而非1秒钟。”

自从因ECG错误导致1例儿童被误认为心梗而接受心导管术治疗后，Snyder医生承担了Ochsner医学中心的ECG审查工作。

“我周六早上上班后发现该儿童已被送往心导管室，并已经注射冠脉造影剂。我赶到那儿说道‘这是导联错接’，但在冠脉造影证明心脏正常后他们甚至还不相信。”这的确是导联连接错误，但护士并未意识到左右两侧反接。

Snyder医生指出，导联错接通常并不会造成过多损害，但的确可导致无谓的超声、Holter检查和随访，如果最初ECG检查操作正确，这些检查本可以避免。

Snyder医生报告无相关利益冲突。

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By: M. ALEXANDER OTTO, Cardiology News Digital Network

VANCOUVER, B.C. – ECG leads were misplaced in 3% of 1,470 pediatric ECGs, based on a review study performed at the Ochsner Medical Center in New Orleans.

Crisscrossed leads were seen in 45 studies; 19 were left arm/left leg reversals, 15 were left arm/right arm reversals, 8 were precordial misplacements, and 3 were right arm/right leg reversals. The majority, 31 of the 45 errors, happened in the pediatric outpatient clinic. Six occurred in the emergency department, and eight in the hospital. While the placements were done by nurses and technicians, pediatric electrophysiologists and other physicians signed off on the reports without catching the mistakes.

Part of the problem "is the high number of ECGs that you have to read, the low reimbursement rate, and people talking" over your shoulder expecting a quick signature because most pediatric ECGs turn up nothing, said senior investigator Dr. Christopher Snyder, a pediatric cardiologist and electrophysiologist formerly at Ochsner, but now with Case Western Reserve University in Cleveland. "Small chests can also make lead placement tricky; the kids were 10.4 years old on average."

That being said, Dr. Snyder said he reviewed all of these cases "in an hour and 20 minutes. You can pick these out pretty easily" from polarity reversals and other signs.

"I think we need to take maybe 3 seconds to interpret ECGs, as opposed to 1," he remarked.

Dr. Snyder undertook the review after an ECG error resulted in a child being sent to the cath lab at Ochsner with a presumed MI.

"I came in on a Saturday morning and found out that this kid was in the cath lab, and he’d already had his coronaries shot. I ran down there and said ‘this is lead reversal,’ but they didn’t buy into it," even after his coronaries turned out to be normal, Dr. Snyder said. The leads were misplaced; the nurse didn’t understand that "left and right are reversed when you’re looking at someone."

In general, lead misplacement doesn’t result in that much harm, but it does lead to echoes, Holters, and follow-up visits that wouldn’t have happened if ECGs had been done right in the first place, he said.

Dr. Snyder said he had no relevant disclosures.