Data analysis of diagnostic accuracies in 12-lead electrocardiogram interpretation by junior medical fellows

Novotný, Tomáš; Bond, Raymond; Andršová, Irena; Koc, Lumír; Šišáková, Martina; Finlay, Dewar; Guldenring, Daniel; Špinar, Jindřich; Malik, Marek

doi:10.1016/j.jelectrocard.2015.08.023

Cited by 29 publications

(41 citation statements)

References 12 publications

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“…Fewer than 25% of general cardiologists and noncardiologists were able to classify all QT intervals correctly as either long or normal. In an examination of cardiology versus noncardiology fellows in interpret ing 12lead ECGs, Novotny et al 463 found that although the rate of correct diagnosis was more frequent by car diology fellows (70.1%) than noncardiology fellows (55.0%), it was still inadequate.…”

Section: Education Of Staffmentioning

confidence: 99%

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Sandau¹,

Funk²,

Auerbach³

et al. 2017

Circulation

206

214

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Background and Purpose: This scientific statement provides an interprofessional, comprehensive review of evidence and recommendations for indications, duration, and implementation of continuous electro cardiographic monitoring of hospitalized patients. Since the original practice standards were published in 2004, new issues have emerged that need to be addressed: overuse of arrhythmia monitoring among a variety of patient populations, appropriate use of ischemia and QT-interval monitoring among select populations, alarm management, and documentation in electronic health records. Methods: Authors were commissioned by the American Heart Association and included experts from general cardiology, electrophysiology (adult and pediatric), and interventional cardiology, as well as a hospitalist and experts in alarm management. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Authors were assigned topics relevant to their areas of expertise, reviewed the literature with an emphasis on publications since the prior practice standards, and drafted recommendations on indications and duration for electrocardiographic monitoring in accordance with the American Heart Association Level of Evidence grading algorithm that was in place at the time of commissioning. Results: The comprehensive document is grouped into 5 sections: (1) Overview of Arrhythmia, Ischemia, and QTc Monitoring; (2) Recommendations for Indication and Duration of Electrocardiographic Monitoring presented by patient population; (3) Organizational Aspects: Alarm Management, Education of Staff, and Documentation; (4) Implementation of Practice Standards; and (5) Call for Research. Conclusions: Many of the recommendations are based on limited data, so authors conclude with specific questions for further research.

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Section: Education Of Staffmentioning

confidence: 99%

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Sandau¹,

Funk²,

Auerbach³

et al. 2017

Circulation

206

214

View full text Add to dashboard Cite

show abstract

“…In contrast, experts are known to use schemes based around the structure of organized knowledge used for diagnostic reasoning16. Previous work has been undertaken looking at the differences between expert and novice groups14 although as indicated in this study and others917, even experts/specialists make mistakes. This led us to look specifically at the differences between those making correct and incorrect interpretations, as opposed to the broader categories of experts and novices.…”

Section: Discussionmentioning

confidence: 79%

Exploring the Relationship Between Eye Movements and Electrocardiogram Interpretation Accuracy

Davies

Brown

Vigo

et al. 2016

Sci Rep

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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.

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“…Physicians from any specialty have to possess the basic skills of ECG interpretation and rapidly identify potentially life-threatening diseases such as acute myocardial infarction and malignant arrhythmias derived from an ECG tracing [15]. Incorrect ECG interpretation can lead to misdiagnosis and inappropriate treatment decisions, including fatal events among patients with suspected cardiac diseases.…”

Section: Discussionmentioning

confidence: 99%

“…Incorrect ECG interpretation can lead to misdiagnosis and inappropriate treatment decisions, including fatal events among patients with suspected cardiac diseases. However, a lack of these basic ECG interpretation skills is still a serious concern among many physicians [15][16][17]. Survey revealed that a significant proportion of medical graduates were unable to correctly interpret ECGs [18].…”

Section: Discussionmentioning

confidence: 99%

Orderly display of limb lead ECGs raises Chinese intern’s diagnostic accuracy when determining frontal plane QRS axis

Banarsee

Laukkanen

et al. 2018

Medical Education Online

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Background: There is limited information on whether the orderly display of limb lead ECGs (electrocardiograms) can facilitate students to determine frontal plane QRS complex wave electrical axis.Objectives: The study investigated whether the orderly display of limb lead ECGs can raise Chinese undergraduate intern’s diagnostic accuracy when determining frontal plane axis.Design: A total of 147 fifth-year undergraduate interns aged between 21 and 25 years were randomly arranged into 2 groups: one group was given classically displayed ECGs of limb leads while the other group was given orderly displayed ECGs of limb leads. They were then taught to determine frontal plane axis with one of the above displays. The intern’s diagnostic accuracy and time used were measured.Results: After teaching, the orderly display can more effectively raise diagnostic accuracy when determining axis as compared to the classical display (76.65 ± 23.16% vs. 68.88 ± 23.21%, P < 0.05), although diagnostic accuracy in axis determination was improved in both groups as compared to the axis determination at baseline (all P < 0.05).Conclusions: Orderly display of limb lead ECGs may raise Chinese intern’s diagnostic accuracy when determining frontal plane axis.

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Data analysis of diagnostic accuracies in 12-lead electrocardiogram interpretation by junior medical fellows

Cited by 29 publications

References 12 publications

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association

Exploring the Relationship Between Eye Movements and Electrocardiogram Interpretation Accuracy

Orderly display of limb lead ECGs raises Chinese intern’s diagnostic accuracy when determining frontal plane QRS axis

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