David Massel1. 1. Department of Medicine, London Health Sciences Centre, University of Western Ontario, Room 205 Colborne Building, Victoria Campus, 375 South Street, London, Ontario, Canada N6A 4G5. dmassel@lhsc.on.ca
Abstract
BACKGROUND: Despite the known benefit of thrombolysis it remains underutilized among eligible patients with acute myocardial infarction. We sought to determine whether potential errors in ECG interpretation might be a contributing factor and to what extent clinical history, a checklist outlining recognized inclusion criteria and a computerized interpretation would influence reliability and accuracy. METHODS: Seventy-five ECGs were interpreted on 8 separate occasions by 9 clinicians (3 cardiologists, 3 cardiology fellows, 3 medical residents) according to a 2 x 2 x 2 factorial design. RESULTS: The overall level of agreement among all raters was substantial with a kappa (kappa) of 70.4%. Intra-observer ECG reading reliability was stronger among cardiologists (CC) as compared with cardiology fellows (CF) and medical residents (MR). Similarly, inter-observer reliability was substantial to very good and a gradient was seen with greater reliability among CC, followed by CF, then MR ( P = 0.0013). CC recommended thrombolysis significantly more frequently ( p < 0.001) than either CF or MR. Trainees were biased by the presence of a computerized ECG interpretation resulting in a decision to recommend thrombolysis administration less often. CONCLUSION: The reliability of ECG interpretation for deciding to administer thrombolysis was substantial; there was a gradient from lowest to highest commensurate with training and experience. Errors in thrombolysis eligibility are influenced by clinical history and the presence of a computerized ECG interpretation among less experienced clinicians.
BACKGROUND: Despite the known benefit of thrombolysis it remains underutilized among eligible patients with acute myocardial infarction. We sought to determine whether potential errors in ECG interpretation might be a contributing factor and to what extent clinical history, a checklist outlining recognized inclusion criteria and a computerized interpretation would influence reliability and accuracy. METHODS: Seventy-five ECGs were interpreted on 8 separate occasions by 9 clinicians (3 cardiologists, 3 cardiology fellows, 3 medical residents) according to a 2 x 2 x 2 factorial design. RESULTS: The overall level of agreement among all raters was substantial with a kappa (kappa) of 70.4%. Intra-observer ECG reading reliability was stronger among cardiologists (CC) as compared with cardiology fellows (CF) and medical residents (MR). Similarly, inter-observer reliability was substantial to very good and a gradient was seen with greater reliability among CC, followed by CF, then MR ( P = 0.0013). CC recommended thrombolysis significantly more frequently ( p < 0.001) than either CF or MR. Trainees were biased by the presence of a computerized ECG interpretation resulting in a decision to recommend thrombolysis administration less often. CONCLUSION: The reliability of ECG interpretation for deciding to administer thrombolysis was substantial; there was a gradient from lowest to highest commensurate with training and experience. Errors in thrombolysis eligibility are influenced by clinical history and the presence of a computerized ECG interpretation among less experienced clinicians.
Authors: J L Willems; C Abreu-Lima; P Arnaud; J H van Bemmel; C Brohet; R Degani; B Denis; J Gehring; I Graham; G van Herpen Journal: N Engl J Med Date: 1991-12-19 Impact factor: 91.245