COMPARATIVE STUDY
JOURNAL ARTICLE

Emergency department interpretation of electrocardiograms

E J Westdrop, M C Gratton, W A Watson
Annals of Emergency Medicine 1992, 21 (5): 541-4
1570910

STUDY OBJECTIVE: To determine the concordance of emergency physicians' and cardiologists' interpretations of abnormal ECGs.

DESIGN: Retrospective cohort study.

SETTING: An urban teaching hospital emergency department.

TYPE OF PARTICIPANTS: Patients with an abnormal ED ECG that was interpreted by both an emergency physician and a cardiologist and who were discharged from the ED.

MEASUREMENTS AND MAIN RESULTS: Seven hundred sixteen ECGs were reviewed; 143 abnormal ECGs were obtained on patients discharged from the ED. The cardiologist's final interpretation was defined as correct, and discordance was any abnormality not identified by the emergency physician. The overall discordance between emergency physicians' and cardiologists' ECG interpretations was 58.0% (P less than .001). Twenty-five discordant interpretations were likely clinically significant--representing missed ischemia, infarct, and abnormal rhythm. There was no ED interpretation in three of these. The most frequently missed findings by emergency physicians were evidence of ischemia/infarct of the anterior wall and atrial fibrillation. Twenty-one of the 83 patients with discordant interpretations were lost to follow-up. Two cases had a clinically significant discrepancy that would have altered patient care.

CONCLUSION: Although the overall discordance was more than 50%, most ED misinterpretations were determined unlikely to have clinical significance. Additional studies are needed to identify variables that contribute to ED ECG misinterpretation and to develop methods to resolve these difficulties.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read
1570910
×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"