Abstract
OBJECTIVES—To determine whether access to a computer generated electrocardiogram (ECG) report can reduce errors of interpretation by senior house officers (SHOs) in an accident and emergency department. METHODS—Ten SHOs were asked to interpret 50 ECGs each: 25 with computer generated reports, 25 without. Their answers, and the computer generated reports, were compared with a "gold standard" produced by two experienced clinicians. The primary outcome measure was the proportion of major errors of interpretation. RESULTS—The computer reading system made two major errors (4%, 95% confidence interval (CI) 1.1% to 13.5%) compared with the gold standard. Access to the computer report did not significantly reduce major errors among SHOs (46 (18.4%) with report v 56 (22.4%) without, odds ratio 0.64, 95% CI 0.36% to 1.14%, p=0.13) or improve the proportion completely correct (104 (41.6%) with report v 91 (36.4%) without, odds ratio 1.43, 95% CI 0.88 to 2.33, p=0.15). CONCLUSIONS—SHOs have a high error rate when interpreting ECGs, which is not significantly reduced by access to a computer generated report. Junior doctors should continue to seek expert senior help when they have to interpret a difficult ECG. Keywords: electrocardiogram; computer reading systems; accident and emergency
Full Text
The Full Text of this article is available as a PDF (102.8 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Brady W. J., Morris F. Electrocardiographic abnormalities encountered in acute myocardial infarction. J Accid Emerg Med. 2000 Jan;17(1):40–45. doi: 10.1136/emj.17.1.40. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Brailer D. J., Kroch E., Pauly M. V. The impact of computer-assisted test interpretation on physician decision making: the case of electrocardiograms. Med Decis Making. 1997 Jan-Mar;17(1):80–86. doi: 10.1177/0272989X9701700109. [DOI] [PubMed] [Google Scholar]
- Hillson S. D., Connelly D. P., Liu Y. The effects of computer-assisted electrocardiographic interpretation on physicians' diagnostic decisions. Med Decis Making. 1995 Apr-Jun;15(2):107–112. doi: 10.1177/0272989X9501500202. [DOI] [PubMed] [Google Scholar]
- Lee T. H., Rouan G. W., Weisberg M. C., Brand D. A., Acampora D., Stasiulewicz C., Walshon J., Terranova G., Gottlieb L., Goldstein-Wayne B. Clinical characteristics and natural history of patients with acute myocardial infarction sent home from the emergency room. Am J Cardiol. 1987 Aug 1;60(4):219–224. doi: 10.1016/0002-9149(87)90217-7. [DOI] [PubMed] [Google Scholar]
- Lee T. H., Weisberg M. C., Brand D. A., Rouan G. W., Goldman L. Candidates for thrombolysis among emergency room patients with acute chest pain. Potential true- and false-positive rates. Ann Intern Med. 1989 Jun 15;110(12):957–962. doi: 10.7326/0003-4819-110-12-957. [DOI] [PubMed] [Google Scholar]
- Morrison W. G., Swann I. J. Electrocardiograph interpretation by junior doctors. Arch Emerg Med. 1990 Jun;7(2):108–110. doi: 10.1136/emj.7.2.108. [DOI] [PMC free article] [PubMed] [Google Scholar]
- White T., Woodmansey P., Ferguson D. G., Channer K. S. Improving the interpretation of electrocardiographs in an accident and emergency department. Postgrad Med J. 1995 Mar;71(833):132–135. doi: 10.1136/pgmj.71.833.132. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Willems J. L., Abreu-Lima C., Arnaud P., van Bemmel J. H., Brohet C., Degani R., Denis B., Gehring J., Graham I., van Herpen G. The diagnostic performance of computer programs for the interpretation of electrocardiograms. N Engl J Med. 1991 Dec 19;325(25):1767–1773. doi: 10.1056/NEJM199112193252503. [DOI] [PubMed] [Google Scholar]