Investigating and Comparing the Diagnostic Value of Exercise Test Protocols in Pediatrics: A Shorter Alternative to the Bruce Method

Background Exercise testing is widely used to assess functional capacity and detect cardiac abnormalities in pediatrics. The standard Bruce protocol, though effective, is lengthy and can challenge compliance, especially in children. Objective This study evaluates the diagnostic value of the modified 4-minute and 8-minute exercise test protocols compared to the standard 21-minute Bruce protocol in terms of sensitivity, specificity, accuracy, and tolerance among children. Materials & Methods In this epidemiological analytical study 76 children under the age of 18 who had an indication for exercise testing were recruited. The study included three exercise protocols: standard Bruce protocol, modified 4-minute Bruce protocol, and modified 8-minute Bruce protocol. Tests were randomly assigned using a simple randomization software into two groups. After an 8–12-minute recovery period, participants switched protocols, ensuring each group completed all three tests. Data were analyzed using SPSS version 24. Descriptive statistics included measures of central tendency, dispersion, and frequency percentages. Sensitivity, specificity, and diagnostic accuracy were calculated for each protocol. Paired t-tests were used for within-group comparisons, while unpaired t-tests assessed differences between groups. Results In this study, 76 patients, 44 boys and 32 girls, were examined. The age of the children varied from 5 to 17 years; we compared the qualitative variables with the standard B method; In most cases, the variables had similar results in the three methods, and we checked the agreement between the two methods with Kappa statistics, which were significant (SIG < 0.05) and its VALUE was closer to 1, which means they were in 100% agreement. Conclusion This study found no significant differences in clinical outcomes among the Bruce, 4-minute, and 8-minute protocols in children. Therefore, the shorter 4-minute and 8-minute protocols can be effectively used as alternatives to the standard Bruce method.