Electrocardiogram interpretation in general practice: relevance to prehospital thrombolysis.
OBJECTIVE
To assess, in the context of their possible role in prehospital thrombolysis, the ability of general practitioners to recognise acute transmural myocardial ischaemia/infarction on an electrocardiogram.


METHODS
150 doctors (every fifth name) were selected from the alphabetical list of 750 on Merseyside general practitioner register and without prior warning were asked to interpret a series of six 12 lead electrocardiograms. Three of these showed acute transmural ischaemia/infarction, one was normal, and two showed non-acute abnormalities. Details of doctors' ages, postgraduate training, and clinical practice were sought.


METHODS
General practitioners' surgeries and postgraduate centres within the Merseyside area.


METHODS
106 general practitioners (mean age 45 years) agreed to participate.


METHODS
Accuracy of general practitioners' interpretations of the six electrocardiograms.


RESULTS
82% of general practitioners correctly recognised a normal electrocardiogram. Recognition of acute abnormalities was less reliable. Between 33% and 61% correctly identified acute transmural ischaemia/infarction depending on the specific trace presented. Accurate localisation of the site of the infarct was achieved only by between 8% and 30% of participants, while between 22% and 25% correctly interpreted non-acute abnormalities. Neither routine use of electrocardiography nor postgraduate hospital experience in general medicine was associated with significantly greater expertise.


CONCLUSIONS
The current level of proficiency of a sample of general practitioners in the Merseyside area in recognising acute transmural ischaemia/infarction on an electrocardiogram suggests that refresher training is needed if general practitioners are to give prehospital thrombolysis.
Department of Cardiology, Royal Liverpool Hospital.
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McCrea
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Saltissi
D000328:Adult; D000368:Aged; D002983:Clinical Competence; D004562:Electrocardiography; D004630:Emergencies; D005194:Family Practice; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D015912:Thrombolytic Therapy; D013997:Time Factors