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Observer variability in ECG interpretation for thrombolysis eligibility: experience and context matter.
1Department of Medicine, London Health Sciences Centre, University of Western Ontario, Room 205 Colborne Building, Victoria Campus, 375 South Street, London, Ontario, Canada N6A 4G5. dmassel@lhsc.on.ca
Journal of Thrombosis and Thrombolysis
|January 24, 2004
Summary
ECG interpretation reliability for thrombolysis is substantial but varies with clinician experience. Less experienced doctors
Area of Science:
- Cardiology
- Medical Diagnostics
- Healthcare Quality Improvement
Background:
- Thrombolysis for acute myocardial infarction (AMI) is underutilized.
- Potential errors in electrocardiogram (ECG) interpretation may contribute to underutilization.
- Factors influencing ECG interpretation accuracy and reliability need investigation.
Purpose of the Study:
- To assess ECG interpretation reliability for thrombolysis decisions.
- To determine the influence of clinical history, checklists, and computerized interpretation on accuracy.
- To evaluate the impact of clinician experience on ECG interpretation.
Main Methods:
- 9 clinicians (cardiologists, fellows, residents) interpreted 75 ECGs.
- A 2x2x2 factorial design was employed.
- Inter- and intra-observer reliability was assessed.
Main Results:
- Substantial overall agreement (kappa=70.4%) among raters.
- Higher reliability observed in cardiologists compared to fellows and residents.
- Computerized interpretation biased less experienced clinicians towards withholding thrombolysis.
Conclusions:
- ECG interpretation reliability for thrombolysis is substantial, with a clear gradient based on training and experience.
- Clinical history and computerized interpretation affect eligibility decisions in less experienced clinicians.
- Improving ECG interpretation accuracy is crucial for optimizing AMI treatment.