Errors in emergency physician interpretation of ST-segment elevation in emergency department chest pain patients
Insights
Emergency physicians accurately interpret electrocardiographic ST-segment elevation in chest pain patients, with a low misinterpretation rate of 5.9%. Clinical consequences of these ECG errors are minimal.
Area of Science:
- Cardiology
- Emergency Medicine
- Diagnostic Imaging
Background:
- Electrocardiograms (ECGs) are crucial for diagnosing acute chest pain.
- ST-segment elevation (STE) on ECG can indicate serious conditions like acute myocardial infarction (AMI).
- Accurate interpretation of ECG STE by emergency physicians (EPs) is vital for timely patient management.
Purpose of the Study:
- To determine the error rate of emergency physician interpretation of ECG ST-segment elevation in adult chest pain patients.
- To assess the clinical significance of misinterpretations in ECG diagnosis.
Main Methods:
- Retrospective review of ECGs from adult chest pain patients in an emergency department.
- Comparison of initial EP ECG interpretations with final cardiologist interpretations.
- Calculation of the misinterpretation rate for ECG ST-segment elevation.
Main Results:
- A total of 202 patients with STEs were analyzed.
- The overall rate of ECG STE misinterpretation by EPs was 5.9% (12 out of 202).
- Left ventricular aneurysm and benign early repolarization (BER) were the most commonly misdiagnosed STE entities.
Conclusions:
- Emergency physicians demonstrate a low rate of misinterpreting ECG ST-segment elevation in chest pain patients.
- The clinical impact of these ECG misinterpretations is considered minimal.
Objective:
To determine the rate of error in emergency physician (EP) interpretation of the cause of electrocardiographic (ECG) ST-segment elevation (STE) in adult chest pain patients.
Methods:
The authors conducted a retrospective ECG review of adult chest pain patients in a university hospital emergency department (ED) over a three-month period (January 1 to March 31, 1996). ST-segment elevation was determined to be present if the ST segment was elevated >/=1 mm in the limb leads and >/=2 mm in the precordial leads in at least two anatomically contiguous leads. Initial EP ECG interpretation was compared with the final interpretation by a cardiologist supported by the results of various clinical investigations. The rate of incorrect ECG diagnosis was calculated.
Results:
Two hundred two patients had STEs. The rate of ECG STE misinterpretation was 12 of 202 (5.9%). The most frequently misdiagnosed form of STE was left ventricular aneurysm, for which two of five cases were believed to represent acute myocardial infarction (AMI). The benign early repolarization (BER) pattern was the second most frequently misinterpreted STE entity-in a total of three cases, two were initially noted to represent pericarditis and one AMI. ST-segment elevation resulting from actual AMI was initially incorrectly noted to be noninfarction in etiology in two cases, one patient with BER and the other with left ventricular hypertrophy.
Conclusions:
Emergency physicians show a low rate of ECG misinterpretation in the patient with chest pain and STE. The clinical consequences of this misinterpretation are minimal.
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