title: The role of computerized diagnostic proposals in the interpretation of the 12-lead electrocardiogram by cardiology and non-cardiology fellows.
abstract: Most contemporary 12-lead electrocardiogram (ECG) devices offer computerized diagnostic proposals. The reliability of these automated diagnoses is limited. It has been suggested that incorrect computer advice can influence physician decision-making. This study analyzed the role of diagnostic proposals in the decision process by a group of fellows of cardiology and other internal medicine subspecialties.
  
  
  
  A set of 100 clinical 12-lead ECG tracings was selected covering both normal cases and common abnormalities. A team of 15 junior Cardiology Fellows and 15 Non-Cardiology Fellows interpreted the ECGs in 3 phases: without any diagnostic proposal, with a single diagnostic proposal (half of them intentionally incorrect), and with four diagnostic proposals (only one of them being correct) for each ECG. Self-rated confidence of each interpretation was collected.
  
  
  
  Availability of diagnostic proposals significantly increased the diagnostic accuracy (p<0.001). Nevertheless, in case of a single proposal (either correct or incorrect) the increase of accuracy was present in interpretations with correct diagnostic proposals, while the accuracy was substantially reduced with incorrect proposals. Confidence levels poorly correlated with interpretation scores (rho≈2, p<0.001). Logistic regression showed that an interpreter is most likely to be correct when the ECG offers a correct diagnostic proposal (OR=10.87) or multiple proposals (OR=4.43).
  
  
  
  Diagnostic proposals affect the diagnostic accuracy of ECG interpretations. The accuracy is significantly influenced especially when a single diagnostic proposal (either correct or incorrect) is provided. The study suggests that the presentation of multiple computerized diagnoses is likely to improve the diagnostic accuracy of interpreters.
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital Brno and Faculty of Medicine of Masaryk University, Brno, Czechia. Electronic address: novotny-t@seznam.cz.
authors.forename: Tomas
authors.initials: T
authors.lastname: Novotny
authors.affiliation: Faculty of Computing and Engineering, Ulster University, Newtownabbey, United Kingdom.
authors.forename: Raymond
authors.initials: R
authors.lastname: Bond
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital Brno and Faculty of Medicine of Masaryk University, Brno, Czechia.
authors.forename: Irena
authors.initials: I
authors.lastname: Andrsova
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital Brno and Faculty of Medicine of Masaryk University, Brno, Czechia.
authors.forename: Lumir
authors.initials: L
authors.lastname: Koc
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital Brno and Faculty of Medicine of Masaryk University, Brno, Czechia.
authors.forename: Martina
authors.initials: M
authors.lastname: Sisakova
authors.affiliation: Faculty of Computing and Engineering, Ulster University, Newtownabbey, United Kingdom.
authors.forename: Dewar
authors.initials: D
authors.lastname: Finlay
authors.affiliation: Faculty of Computing and Engineering, Ulster University, Newtownabbey, United Kingdom.
authors.forename: Daniel
authors.initials: D
authors.lastname: Guldenring
authors.affiliation: Department of Internal Medicine and Cardiology, University Hospital Brno and Faculty of Medicine of Masaryk University, Brno, Czechia.
authors.forename: Jindrich
authors.initials: J
authors.lastname: Spinar
authors.affiliation: St. Paul's Cardiac Electrophysiology and Imperial College, London, United Kingdom.
authors.forename: Marek
authors.initials: M
authors.lastname: Malik
mesh_terms: D001145:Arrhythmias, Cardiac / Q000175:diagnosis*; D002309:Cardiology; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003951:Diagnostic Errors / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000706:statistics & numerical data*; D006801:Humans; D015588:Observer Variation
keywords: Computerized diagnostic proposals; Decision making; Electrocardiogram interpretations