Variation in patient management based on ECG interpretation by emergency medicine and internal medicine residents.
This study was performed to determine the impact of electrocardiogram (ECG) interpretation on urgent patient care decisions by internal medicine (IM) and emergency medicine (EM) resident physicians. Six clinical scenarios and ECGs were given to 31 IM residents and 31 EM residents at a university medical center. Based on the ECG interpretation, the residents were asked to select the best patient management from a list of choices. IM and EM residents were equally likely to choose the correct management for complete heart block (90% IM v 97% EM, P = NS), and pulseless ventricular tachycardia (VT) (94% IM v 97% EM, P = NS). IM residents were less likely to choose the correct management for acute posterior wall myocardial infarction (MI) (26% IM v 74% EM, P <.0001) and unstable supraventricular tachycardia (SVT) (87% IM v 100% EM, P <.05). Residents in both programs were equally likely to misinterpret left ventricular hypertrophy (LVH) (23% IM and 16% EM, P = NS) and benign early repolarization (BER) (48% IM and 52% EM, P = NS) as acute myocardial ischemia when presented with a clinical history not suggestive of cardiac ischemia. IM and EM residents were equally likely to choose the correct management for complete heart block and pulseless VT. Compared with EM residents, IM residents were less likely to choose the correct management of posterior wall MI and unstable SVT. Both IM and EM residents were prone to misinterpreting LVH and BER as acute myocardial ischemia. Resident education in both specialties should focus on ECG interpretation skills to improve patient management decisions.
Trzeciak
Stephen
S
Combined Emergency Medicine/Internal Medicine Residency Program, Department of Emergency Medicine, University of Illinois at Chicago, College of Medicine, Chicago, IL 60612, USA. stevetrzeciak@hotmail.com
Erickson
Timothy
T
Bunney
E Bradshaw
EB
Sloan
Edward P
EP
D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000628:therapy; D003657:Decision Making; D003951:Diagnostic Errors; D004562:Electrocardiography; D004635:Emergency Medicine / Q000193:education*; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D014481:United States