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Related Experiment Videos

Observer variation in measured ST-segment elevation.

D Tandberg1, K D Kastendieck, S Meskin

  • 1Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA. Tandberg@salud.unm.edu

Annals of Emergency Medicine
|September 28, 1999
PubMed
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Measurements of ST-segment elevation in myocardial infarction diagnosis show significant intraobserver variation. This variability can lead to inconsistent classification of patients eligible for thrombolytic therapy.

Area of Science:

  • Cardiology
  • Medical Diagnostics
  • Electrocardiography

Background:

  • ST-segment elevation on ECG is crucial for immediate decisions regarding thrombolytic therapy in suspected myocardial infarction.
  • Assessing the reliability of ST-segment measurements is vital for accurate patient stratification.

Purpose of the Study:

  • To evaluate interobserver and intraobserver variability in the measurement of ST-segment elevation from isolated electrocardiogram (ECG) complexes.
  • To determine the impact of measurement variability on the classification of patients for thrombolytic therapy.

Main Methods:

  • A masked, paired-sample experiment involving emergency physicians, residents, and medical students measuring ST-segment elevations in 40 isolated ECG complexes.
  • Analysis of measurement differences using summary statistics and weighted kappa values to assess agreement.

Related Experiment Videos

  • 1-factor analysis of variance used to test for differences among groups.

    • Main Results:

    • Fifty-two subjects measured 2,070 ST segments; the mean difference was 0.28 mm, with a 95th percentile difference of 0.9 mm.
    • Statistical agreement between paired measurements was very good (kappa=0.85).
    • However, 14% of paired estimations resulted in inconsistent classifications when using a 2.0 mm threshold for ST-segment elevation, indicating potential misclassification.

    Conclusions:

    • Intraobserver measurements of ST-segment elevation can differ by over 0.5 mm approximately 20% of the time.
    • Independent interpretations of the same ST segment by the same reader led to different treatment classifications 14% of the time.
    • This variability poses a risk of misclassifying patients who could benefit from thrombolytic therapy.