title: Emergency physician accuracy in interpreting electrocardiograms with potential ST-segment elevation myocardial infarction: Is it enough?
abstract: BACKGROUND
  Electrocardiogram (ECG) interpretation is widely performed by emergency physicians. We aimed to determine the accuracy of interpretation of potential ST-segment elevation myocardial infarction (STEMI) ECGs by emergency physicians.
  
  
  METHODS
  Thirty-six ECGs resulted in putative STEMI diagnoses were selected. Participants were asked to focus on whether or not the ECG in question met the diagnostic criteria for an acutely blocked coronary artery causing a STEMI. Based on the coronary angiogram, a binary outcome of accurate versus inaccurate ECG interpretation was defined. We computed the overall sensitivity, specificity, accuracy and 95% confidence intervals (95%CIs) for ECG interpretation. Data on participant training level, working experience and place were collected.
  
  
  RESULTS
  135 participants interpreted 4603 ECGs. Overall sensitivity to identify 'true' STEMI ECGs was 64.5% (95%CI: 62.8-66.3); specificity in determining 'false' ECGs was 78% (95%CI: 76-80.1). Overall accuracy was modest (69.1, 95%CI: 67.8-70.4). Higher accuracy in ECG interpretation was observed for attending physicians, participants working in tertiary care hospitals and those more experienced.
  
  
  CONCLUSIONS
  The accuracy of interpretation of potential STEMI ECGs was modest among emergency physicians. The study supports the notion that ECG interpretation for establishing a STEMI diagnosis lacks the necessary sensitivity and specificity to be considered a reliable 'stand-alone' diagnostic test.
authors.affiliation: a Department of Emergency Medicine , ASST Grande Ospedale Metropolitano Niguarda, University of Milano-Bicocca , Milan , Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Veronese
authors.affiliation: b Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Germini
authors.affiliation: c Department of Emergency Medicine , ASST Papa Giovanni XXIII , Bergamo , Italy.
authors.forename: Stella
authors.initials: S
authors.lastname: Ingrassia
authors.affiliation: d Department of Emergency Medicine , IRCCS Azienda Ospedaliera Universitaria San Martino-IST , Genova , Italy.
authors.forename: Ombretta
authors.initials: O
authors.lastname: Cutuli
authors.affiliation: e Department of Emergency Medicine , Ospedale San Donato , Arezzo , Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Donati
authors.affiliation: a Department of Emergency Medicine , ASST Grande Ospedale Metropolitano Niguarda, University of Milano-Bicocca , Milan , Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Bonacchini
authors.affiliation: b Geriatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy.|f Department of Clinical Sciences and Community Health , University of Milan , Milan , Italy.
authors.forename: Maura
authors.initials: M
authors.lastname: Marcucci
authors.affiliation: g Department of Emergency Medicine , Ospedale Morgagni-Pierantoni , Forlì , Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fabbri
mesh_terms: D002983:Clinical Competence / Q000592:standards; D017023:Coronary Angiography / Q000379:methods / Q000706:statistics & numerical data; D003951:Diagnostic Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D061827:Dimensional Measurement Accuracy; D004562:Electrocardiography / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards; D019538:Health Care Surveys; D006801:Humans; D007558:Italy; D010820:Physicians / Q000592:standards / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis*; D012680:Sensitivity and Specificity
keywords: Accuracy; electrocardiogram; emergency medicine; myocardial infarction