儿童心脏猝死是一种罕见的事件,但具有重大的社会意义。一般来说,它与心脏病有关,有心脏猝死(SCD)的风险,可能伴随心血管症状和/或心电图标志物而发生;因此,初级保健儿科医生(PCP)可以发现它们.因此,我们提出了一项研究,评估如何在六岁和十二岁的常规健康儿童检查中付诸实践并进行心血管评估;反映心血管体征和症状,以及选定人群中存在SCD风险的儿童的心电图改变;并评估PCP的心电图(ECG)解释能力。与PCP合作,初级护理护士,和儿科心脏病专家,一个观察,描述性,描述性多中心,横断面研究在巴利阿里群岛(西班牙)进行,从2021年4月到2022年1月,包括在内。PCP通过表格收集患者数据(病历,心电图,和体检),并将其发送给调查员,连同知情同意书和心电图。调查人员将心电图交给儿科心脏病专家阅读,与儿科医生填写的表格相同。收集了变量,并进行了描述性分析。三位儿科心脏病专家,十二个PCP,来自七个公共卫生中心的九名护士参加了会议。他们收集了641名患者的数据,但233例患者未参与(81.11%因PCP的工作量).因此,研究覆盖率约为64%,代表参与的患者总数的商,除以符合研究条件的患者总数.我们检测到30例心电图改变与SCD风险相符的患者。其中9个曾由儿科心脏病专家检查过(8/9功能性杂音),五个人报告说运动时呼吸急促,四个人报告有猝死的家族史。所有心电图与SCD风险相符的患者的体格检查均正常。在分析PCP和儿科心脏病专家的心电图结果在多大程度上一致后,最终解释(正常/改变)的一致性百分比为91.9%,科恩的卡帕系数为31.2%(CI95%:13.8-48.6%)。PCP进行ECG解释以检测与SCD风险相容的ECG的敏感性为29%,阳性预测值为45%。结论:本研究为未来儿童SCD风险筛查奠定了基础。由PCP执行。然而,以前,重要的是优化他们在阅读和解释儿科心电图方面的培训。什么是已知的:•目前在西班牙,有一个项目可以检测有猝死风险的心脏病[1],但它只针对作为一项联邦运动开始或正在进行体育活动的儿童。在几个国家[2],实施此类筛查计划已被证明是有效的。然而,一些研究表明,参加体育活动的儿童心源性猝死的发生率并不比不参加任何运动的儿童高[3]。这构成了道德冲突,因为目前,不参加任何联合会运动的儿童将被排除在筛查之外。根据修订后的文献,到目前为止,只有在两项研究中,他们对学校的儿童群体进行了筛查,在两者中,他们成功地检测到心脏病患者与猝死风险相关[4,5]。我们没有发现任何研究将这些特征的筛查纳入初级保健儿科医生的常规健康儿童检查中。新增内容:•我们不知道是否-在我们的设置中,目前,初级保健儿科医生可以在常规的健康儿童检查中进行筛查方法,为了检测可能有心脏猝死风险的健康儿童,因为它们存在SCD风险之一。在这方面,我们提出了我们的项目:评估初级保健儿科医生如何在健康儿童人群中实施和通过SCD风险筛查进行心血管评估,并评估初级保健儿科医生识别与SCD风险相关的心电图改变的技能.这项试点研究的最终目的是使之成为可能,在未来,设计和证明一项旨在普及心血管筛查和实现儿童心源性猝死事件长期减少的研究。
Sudden cardiac death in children is a rare event, but of great social significance. Generally, it is related to heart disease with a risk of sudden cardiac death (SCD), which may occur with cardiovascular symptoms and/or electrocardiographic markers; thus, a primary care paediatrician (PCP) could detect them. Therefore, we proposed a
study that assesses how to put into practice and conduct a cardiovascular assessment within the routine healthy-child check-ups at six and twelve years of age; that reflects cardiovascular signs and symptoms, as well as the electrocardiographic alterations that children with a risk of SCD in the selected population present; and that assesses the PCP\'s skill at electrocardiogram (ECG) interpretation. In collaboration with PCPs, primary care nurses, and paediatric cardiologists, an observational, descriptive, multicentre, cross-sectional
study was carried out in the Balearic Islands (Spain), from April 2021 to January 2022, inclusive. The PCPs gathered patient data through forms (medical record, electrocardiogram, and physical examination) and sent them to the investigator, together with the informed consent document and electrocardiogram. The investigator passed the electrocardiogram on to the paediatric cardiologists for reading, in an identical form to those the paediatricians had filled in. The variables were collected, and a descriptive analysis performed. Three paediatric cardiologists, twelve PCPs, and nine nurses from seven public health centres took part. They collected the data from 641 patients, but 233 patients did not participate (in 81.11% due to the PCP\'s workload). Therefore, the
study coverage was around 64%, representing the quotient of the total number of patients who participated, divided by the total number of patients who were eligible for the
study. We detected 30 patients with electrocardiographic alterations compatible with SCD risk. Nine of these had been examined by a paediatric cardiologist at some time (functional murmur in 8/9), five had reported shortness of breath with exercise, and four had reported a family history of sudden death. The physical examination of all the patients whose ECG was compatible with a risk of SCD was normal. Upon analysing to what extent the ECG results of the PCP and the paediatric cardiologist agreed, the percentage of agreement in the final interpretation (normal/altered) was 91.9%, while Cohen\'s kappa coefficient was 31.2% (CI 95%: 13.8-48.6%). The sensitivity of the ECG interpretation by the PCP to detect an ECG compatible with a risk of SCD was 29% and the positive predictive value 45%. Conclusions: This
study lays the foundations for future SCD risk screening in children, performed by PCPs. However, previously, it would be important to optimise their training in reading and interpreting paediatric ECGs. What is Known: • In Spain at present, there is a programme in place to detect heart disease with a risk of sudden death [1], but it targets only children who are starting on or are doing a physical activity as a federated sport. Implementing such screening programmes has proven effective in several countries [2]. However, several studies showed that the incidence of sudden cardiac death is no higher in children competing in sport activities than in those who do not do any sport [3]. This poses an ethical conflict, because at present, children who do not do any federated sport are excluded from screening. According to the revised literature, so far, only in two studies did they screen the child population at schools, and in both, they successfully detected patients with heart disease associated to the risk of sudden death [4, 5]. We have found no studies where the screening of these features was included within the routine healthy-child check-ups by primary care paediatricians. What is New: • We did not know whether-in our setting, at present-the primary care paediatrician could perform a screening method within the routine healthy-child check-ups, in order to detect presumably healthy children at risk of sudden cardiac death, as they present one of the SCD risks. In this regard, we proposed our project: to assess how to put into practice and conduct a cardiovascular assessment via SCD risk screening in the healthy child population by primary care paediatricians and appraise primary care paediatricians\' skills in identifying the electrocardiographic alterations associated with SCD risk. The ultimate intention of this pilot study was to make it possible, in the future, to design and justify a study aimed at universalising cardiovascular screening and achieving a long-term decrease in sudden cardiac death events in children.