title: The development and validation of an early warning system to prevent the acquisition of 12-lead resting ECGs with interchanged electrode positions.
abstract: BACKGROUND
  A fraction of routine resting ECG's are taken with electrode positions interchanged, leading to possible clinical misinterpretation.
  
  
  OBJECTIVE
  Develop and test a method to detect and prevent electrode reversals at the electrocardiograph before the ECG is acquired.
  
  
  METHODS
  The algorithm is based on QRS axis and P amplitudes for limb electrode reversals, and P-Q-RS amplitude distances to detect chest electrode reversals. The evaluation method involved a large (>18,000) hospital database for which serial ECG's were available and was based on simulated juxtapositions.
  
  
  RESULTS
  The 7 most common lead reversals could be detected with a specificity of 99.8% per type and an average sensitivity of 90%, excluding LA-LL reversal (22% sensitivity).
  
  
  CONCLUSIONS
  Results are similar to retrospective studies that used smaller, more homogeneous datasets.
  
  
  CONCLUSIONS
  The early warning system reduces the ECG's recorded with reversal by 80%, at the price of a modest false alert rate of 1.4%.
authors.affiliation: Mortara Instrument Inc., 7865 North 86th Street, 53224 Milwaukee, WI, USA. Electronic address: johan.debie@mortara.com.
authors.forename: Johan
authors.initials: J
authors.lastname: de Bie
authors.affiliation: Mortara Instrument Inc., 7865 North 86th Street, 53224 Milwaukee, WI, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Mortara
authors.affiliation: Mortara Instrument Inc., 7865 North 86th Street, 53224 Milwaukee, WI, USA.
authors.forename: Todd F
authors.initials: TF
authors.lastname: Clark
mesh_terms: D000465:Algorithms; D001145:Arrhythmias, Cardiac / Q000175:diagnosis*; D056902:Clinical Alarms; D003199:Computer Systems; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D003951:Diagnostic Errors / Q000517:prevention & control*; D004562:Electrocardiography / Q000295:instrumentation* / Q000379:methods*; D004566:Electrodes; D005260:Female; D006801:Humans; D008297:Male; D010363:Pattern Recognition, Automated / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Automatic detection; ECG; Electrocardiogram; Electrode interchange; Electrode misplacement; Electrode reversal