title: ECG interpretation during the acute phase of coronary syndromes: in need of improvement?
abstract: OBJECTIVE
  Emergency room (ER) interpretation of the ECG is critical to assessment of patients with acute coronary syndromes (ACS). Our aim was to assess its reliability in our institution, a tertiary teaching hospital.
  
  
  METHODS
  Over a 6-month period all consecutive patients admitted for ACS were included in the study. ECG interpretation by emergency physicians (EPs) was recorded on a preformatted sheet and compared with the interpretation of two specialist physicians (SPs). Discrepancies between the 2 specialists were resolved by an ECG specialist.
  
  
  RESULTS
  Over the 6-month period, 692 consecutive patients were admitted with suspected ACS. ECG interpretation was available in 641 cases (93%). Concordance between SPs was 87%. Interpretation of normality or abnormality of the ECG was concordant between EPs and SPs in 475 cases (74%, kappa = 0.51). Interpretation of ischaemic modifications was concordant in 69% of cases, and as many ST segment elevations were unrecognised as overdiagnosed (5% each). The same findings occurred for ST segment depressions and negative T waves (12% each).
  
  
  CONCLUSIONS
  Interpretation of the ECG recorded during ACS by 2 SPs was discrepant in 13% of cases. Similarly, EP interpretation was discrepant from SP interpretation in 25% of cases, equally distributed between over- and underdiagnosing of ischaemic changes. The clinical implications and impact of medical education on ECG interpretation require further study.
authors.affiliation: Service of Cardiology, CHUV, Lausanne, Switzerland.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Berger
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Meier
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Stauffer
authors.forename: Philippe
authors.initials: P
authors.lastname: Eckert
authors.forename: Jürg
authors.initials: J
authors.lastname: Schlaepfer
authors.forename: Dominique
authors.initials: D
authors.lastname: Gillis
authors.forename: Jacques
authors.initials: J
authors.lastname: Cornuz
authors.forename: Bertrand
authors.initials: B
authors.lastname: Yersin
authors.forename: Marie-Denise
authors.initials: MD
authors.lastname: Schaller
authors.forename: Lukas
authors.initials: L
authors.lastname: Kappenberger
authors.forename: Jean-Blaise
authors.initials: JB
authors.lastname: Wasserfallen
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D003327:Coronary Disease / Q000175:diagnosis* / Q000503:physiopathology*; D004562:Electrocardiography / Q000379:methods; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013577:Syndrome