title: Missed myocardial ischaemia in the accident & emergency department: E.C.G. a need for audit?
abstract: Accident & Emergency Department Senior House Officers rely heavily on their ECG interpretation skills in the diagnosis and management of patients with chest pain. This prospective double-blind study was designed to test the accuracy with which Accident & Emergency Senior House Officers interpret ECGs, by comparing their interpretation with that of a Consultant Cardiologist. ECGs from 279 of 314 consecutive patients with chest pain were analysed. Ninety per cent of normal electrocardiographs and 57% of abnormal ECGs were correctly interpreted. Despite the inaccurate interpretation of 43% of abnormal ECGs, 96.5% of the patients in the study were considered to have been managed correctly. Audit of all ECGs recorded in the Accident & Emergency Department should be undertaken by someone with experience of ECG interpretation. New A&E staff should receive training in the interpretation of ECGs.
authors.affiliation: Accident and Emergency Department, Ulster Hospital, Dundonald, Belfast, Northern Ireland.
authors.forename: W A
authors.initials: WA
authors.lastname: McCallion
authors.forename: P A
authors.initials: PA
authors.lastname: Templeton
authors.forename: L A
authors.initials: LA
authors.lastname: McKinney
authors.forename: J D
authors.initials: JD
authors.lastname: Higginson
mesh_terms: D002309:Cardiology / Q000592:standards; D003951:Diagnostic Errors; D004311:Double-Blind Method; D004562:Electrocardiography / Q000592:standards*; D004635:Emergency Medicine / Q000193:education / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology; D009660:Northern Ireland / Q000453:epidemiology; D011237:Predictive Value of Tests; D011446:Prospective Studies