Interpretation of electrocardiograms (ECGs) is a complex task involving visual inspection. This paper aims to improve understanding of how practitioners perceive ECGs, and determine whether visual behaviour can indicate differences in interpretation accuracy. A group of healthcare practitioners (n = 31) who interpret ECGs as part of their clinical role were shown 11 commonly encountered ECGs on a computer screen. The participants’ eye movement data were recorded as they viewed the ECGs and attempted interpretation. The Jensen-Shannon distance was computed for the distance between two Markov chains, constructed from the transition matrices (visual shifts from and to ECG leads) of the correct and incorrect interpretation groups for each ECG. A permutation test was then used to compare this distance against 10,000 randomly shuffled groups made up of the same participants. The results demonstrated a statistically significant (α  0.05) result in 5 of the 11 stimuli demonstrating that the gaze shift between the ECG leads is different between the groups making correct and incorrect interpretations and therefore a factor in interpretation accuracy. The results shed further light on the relationship between visual behaviour and ECG interpretation accuracy, providing information that can be used to improve both human and automated interpretation approaches.

Background/Aims: This article aims to improve the understanding of the applied cognitive processes when interpreting electrocardiograms in clinical practice. It will do this by examining the self-reported approach practitioners take to interpret any barriers they encounter. Methods: This was a qualitative study in which medical practitioners, who routinely interpret electrocardiograms (n=31), were interviewed. The semi-structured interviews covered: their experience of interpretation; use of a system; pitfalls; changes to approach over time. An inductive thematic analysis was used to identify commonly occurring themes. A further set of practitioners (n=31), completed surveys that concerned their approach to an interpretation and use of interpretation frameworks/systems. Results: Practitioners find it easier to interpret electrocardiograms as they gain experience, but the process remains difficult. Barriers to successful interpretation include artefacts altering the waveform, lack of familiarity with the presenting condition, stress/panic at the prospect of making an inaccurate judgement, and overconfidence in one's interpretation abilities. Conclusions: The results support a dual-process system model that is developed with experience and enhances performance. Over time, experienced practitioners become able to move fluidly between a more formal systematic method and an experience-driven pattern recognition system. Potential errors that may arise from a reliance on pattern recognition (e.g. missing details) can be mitigated by using a systematic approach.

Background: To determine the clinical outcomes following fibula nail fixation and to identify the indication for the use of fibula nails in lower limb fractures. Methods: Retrospective study of adult patients from 2 major trauma centers (MTCs) and 9 trauma units (TUs) who underwent fibula nail fixation for AO/OTA 44 fractures between January 1, 2018, and October 31, 2020. Outcome measures included infection, metalwork complications, nonunion or malunion, time to union, and length of inpatient hospital stay. Results: Ninety-five patients were included, with a mean age of 66 years; 57.9% of patients were female. The average body mass index was 30. Sixty-nine patients (72.6%) sustained a Weber B and 24 (27.4%) sustained a Weber C fracture. In addition, 26.3% were open fractures and all patients had soft tissue compromise affecting the lateral malleolus. The calculated infection rate for fibula nail was 4.2% and metalwork complication rate was 5.2%. The nonunion and malunion rate was 8.4% and rate of removal of hardware was 2.1%. The average time to union was 12.5 weeks, and length of inpatient stay was 9.4 days (SD 10). Conclusion: This multicenter study demonstrates that use of a fibula nail appears to be a safe approach to treating patients who have a physiologically higher risk of surgery, poor skin condition, and a complex fracture pattern.