5 The Diagnostic Yield of the Exercise Stress Test in Children with Exercise-Related Symptoms
Bibliographic record
Abstract
Exercise-stress testing is routinely performed to investigate symptoms of dyspnea, presyncope, syncope, and chest pain in pediatric patients. Most children who report exercise-related symptoms have a normal exercise stress test. Despite the routine use and utility of this test, the diagnostic yield in non-cardiac disease populations is not well described. The purpose of this study is to determine the outcome of exercise-stress testing in pediatric patients who reported exercise-related symptoms and had no known pre-existing cardiac disease. We retrospectively reviewed all exercise stress tests from June 2016-January 2018, performed in the Exercise Physiology Laboratory at a tertiary Children’s Hospital. We identified 142 children between the ages of 5–18 years (mean age, SD = 14.0 +/- 2.6 years) who were referred for exercise-related symptoms with no underlying health conditions. Exercise stress tests were performed on a treadmill, starting at a speed of 2.0 mph, increasing by 0.5 mph every minute. Children were instructed to exercise to volitional fatigue with an aim of reaching a heart rate of >200 bpm. 72 children (51%) were female. Exercise related symptoms / reason for referral and exercise stress test outcomes are shown in Table 1. 139 children (98%) had a normal exercise stress test despite their reports of exercise-related symptoms. Symptoms were reproducible in 27 (19%) of patients. Three children (2%) required further investigation due to findings from the stress test. All patients with a normal exercise stress test result were counselled to engage in physical activity with no restrictions. The diagnostic yield of the exercise stress test in children reporting exertional symptoms is low. Approximately 2% of children had findings from their exercise stress test that required further investigations. A normal exercise stress test may play an important role in reassuring patients and their families. Future study is planned to determine if patients return to their baseline physical activity levels after a normal exercise stress test.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".