OBJECTIVE: @entity2270 ( @entity2270 ) on the electrocardiogram (ECG) is associated with @entity299 ( @entity299 ), prompting the clinician to order further testing when evaluating a @entity1 with this finding. The purpose is to (1) compare the @entity4270 ( @entity4270 ) by a pediatric cardiologist to echocardiogram (ECHO) findings in @entity1 with @entity2270 on resting ECG and (2) assess cost of performing ECHO on all @entity1 with @entity2270 on ECG. DESIGN: An IRB approved, retrospective cohort study was performed on @entity1 with @entity2270 (QRS axis >= 0   to -90  ) on ECG between 01/02 and 12/12. INCLUSION CRITERIA: age >0.25 and <18 years, non-postoperative, and @entity4270 and ECHO by pediatric cardiologist. A decision tree model analyzed cost of ECHO in @entity1 with @entity2270 and normal/abnormal @entity4270 . Cost of complete ECHO ( 239.00) was obtained from 2014 Medicare reimbursement rates. RESULTS: A total of 146 @entity1 met inclusion criteria with 46.5% (68) having normal @entity4270 and ECHO, 1.4% (2) having normal @entity4270 and abnormal ECHO, 47.3% (69) having abnormal @entity4270 and ECHO, and 4.8% (7) having an abnormal @entity4270 and normal ECHO. Sensitivity and specificity of @entity4270 for detecting abnormalities in this population was 97% and 90%. Positive and negative predictive value of @entity4270 was 91% and 97.5%. In @entity1 with normal @entity4270 , the cost to identify an ECHO abnormality was  8365, and  263 for those with abnormal @entity4270 . CONCLUSION: In presence of @entity2270 on ECG, the sensitivity, specificity, and positive and negative predictive values of @entity4270 by a pediatric cardiologist are excellent at identifying @entity299 . Performing an ECHO on @entity1 with @entity2270 on ECG is only cost effective in the presence of an abnormal @entity4270 . In the presence of normal @entity4270 , there is a possibility of missing incidental structural @entity299 in approximately 2% if an ECHO is not performed.

Clinical and Financial Impact of Ordering an Echocardiogram in XXXX with Left Axis Deviation on Their Electrocardiogram.

@entity2270 :: ('MESH:C566610', 'Disease') :: ['LAD', 'Left axis deviation'] @entity1 :: ('9606', 'Species') :: ['patients', 'patient'] @entity4270 :: ('MESH:D059445', 'Disease') :: ['physical examination', 'PE'] @entity299 :: ('MESH:D006331', 'Disease') :: ['cardiac disease', 'CHD', 'congenital heart disease']
@entity1 :: (9606,Species) :: ['Children']
