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Comparison of electrocardiogram interpretations by family physicians, a computer, and a cardiology service
1Department of Family Medicine, East Carolina University School of Medicine, Greenville, NC 27858.
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Family physicians
Area of Science:
- Cardiology
- Family Medicine
- Medical Informatics
Background:
- Family physicians face pressure to transfer electrocardiogram (ECG) interpretation to cardiologists.
- The study evaluates the quality of family physician ECG interpretations and the utility of computerized backup.
Purpose of the Study:
- Assess if family physician ECG interpretations warrant transfer to cardiologists.
- Determine if a computerized ECG interpretation program can effectively assist family physicians.
Main Methods:
- Family practice faculty and residents interpreted 301 ECGs over 11 months.
- Interpretations were compared against a computerized program, cardiology service, and a reference electrocardiographer.
- Discrepancies with clinical significance were analyzed.
Main Results:
- Family physicians showed a 33% discrepancy rate with the reference standard on clinically significant ECG findings.
- Computer interpretation agreed with the reference standard in 63% of discrepancies.
- Cardiologist interpretation agreed with the reference standard in 71% of discrepancies (not statistically different from computer).
Conclusions:
- Family physician ECG interpretation agreement with the reference standard is comparable to expert interrater agreement.
- Expert review improved family physician ECG reading quality.
- Computer-assisted ECG interpretation quality is comparable to cardiology service review and offers immediate availability.
Background:
Some family physicians may be under pressure to relinquish the interpretation of outpatient electrocardiograms to cardiologists. The purpose of this study was to determine whether the quality of electrocardiogram (ECG) interpretations by family physicians justifies this pressure, and whether an immediately available computerized ECG interpretation program could serve as an appropriate backup for the family physician.
Methods:
Family practice faculty and residents at a university-based residency program provided written interpretations of 301 ECGs ordered over an 11-month period. Their ECG findings were compared with those from a computerized interpretation program and the readings of the cardiology service. All interpretations were then compared with those of a fellowship-trained electrocardiographer, whose readings served as the reference standard.
Results:
Discrepancy was found between the family physician and the electrocardiographer on 33% of those items that had any potential clinical significance. The computer interpretation and the cardiologist's interpretation agreed with that of the electrocardiographer on 63% and 71% of these discrepancies, respectively (not statistically different).
Conclusions:
Family physicians reached a level of agreement with the reference standard in ECG interpretation that was comparable to previously published reports for expert interrater agreement. In this study, however, the quality of ECG readings by family physicians was further improved by expert review. The quality of computer-assisted ECG interpretation was comparable to that of review provided by a cardiology service. Furthermore, computerized interpretation may be clinically more useful because it is immediately available.