ECG interpretation during the acute phase of coronary syndromes: in need of improvement?
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.
Berger
Alexandre
A
Service of Cardiology, CHUV, Lausanne, Switzerland.
Meier
Jean-Marc
JM
Stauffer
Jean-Christophe
JC
Eckert
Philippe
P
Schlaepfer
Jürg
J
Gillis
Dominique
D
Cornuz
Jacques
J
Yersin
Bertrand
B
Schaller
Marie-Denise
MD
Kappenberger
Lukas
L
Wasserfallen
Jean-Blaise
JB
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