title: Interpretation of electrocardiogram images sent through the mobile phone multimedia messaging service.
abstract: OBJECTIVE
  In this study, the diagnostic accuracy of interpretations of electrocardiogram (ECG) images taken by a mobile phone and sent as multimedia message was investigated.
  
  
  METHODS
  The ECGs of 305 patients who were admitted to the emergency department with cardiac complaints were photographed with the camera of a Nokia (Espoo, Finland) N93 mobile phone. The images were sent via a multimedia messaging system to an identical mobile phone carried by a cardiologist and were interpreted on the screen of that mobile phone. Another cardiologist and an emergency physician interpreted ECG paper printouts separately. The findings of the core laboratory were used as the gold standard. The interpretation errors were scaled from 1 to 4 with respect to the significance of findings.
  
  
  RESULTS
  The total ratio of Grade 4 errors, which consisted of significant errors, did not show any significant difference (p=0.76) between the interpretations by the emergency medicine specialist and the cardiologist who interpreted the ECGs on the mobile phone; the cardiologist who interpreted the ECG paper printouts made significantly fewer mistakes than the other two specialists (p=0.025 and p=0.023, respectively). The separate assessment of the findings showed that in the diagnostic process of ST-segment elevation, depression, and supraventricular tachycardia, the consistency of the interpretations (κ=0.81, κ=0.81, and κ=1.0, respectively) made on the mobile phone screen was slightly better than that of the emergency medicine specialist (κ=0.73, κ=0.77, and κ=0.80, respectively) and was similar to that of the cardiologist (κ=0.91, κ=0.91, and κ=1.0, respectively) who interpreted ECG paper printouts.
  
  
  CONCLUSIONS
  Our findings suggest that sending the ECG images via a multimedia message service may be a practical and inexpensive telecardiology procedure.
authors.affiliation: Department of Cardiology, Faculty of Medicine, Başkent University, Ankara, Turkey. muhammetbilgi@hotmail.com
authors.forename: Muhammet
authors.initials: M
authors.lastname: Bilgi
authors.forename: Betül
authors.initials: B
authors.lastname: Gülalp
authors.forename: Tansel
authors.initials: T
authors.lastname: Erol
authors.forename: Hakan
authors.initials: H
authors.lastname: Güllü
authors.forename: Özlem
authors.initials: Ö
authors.lastname: Karagün
authors.forename: Hakan
authors.initials: H
authors.lastname: Altay
authors.forename: Haldun
authors.initials: H
authors.lastname: Müderrisoğlu
mesh_terms: D022126:Access to Information; D002318:Cardiovascular Diseases / Q000175:diagnosis; D040421:Cell Phone / Q000295:instrumentation*; D004562:Electrocardiography / Q000295:instrumentation*; D004636:Emergency Service, Hospital; D006801:Humans; D019212:Multimedia; D011237:Predictive Value of Tests; D013223:Statistics as Topic; D017216:Telemedicine / Q000295:instrumentation* / Q000379:methods / Q000458:organization & administration; D060145:Text Messaging / Q000295:instrumentation*; D014421:Turkey