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Related Experiment Videos

Inter- and intraobserver variability in LVH and RVH reporting in pediatric ECGs.

R M Hamilton1, K McLeod, A B Houston

  • 1University Department of Medical Cardiology, Glasgow G31 2ER, UK.

Annals of Noninvasive Electrocardiology : the Official Journal of the International Society for Holter and Noninvasive Electrocardiology, Inc
|July 21, 2005
PubMed
Summary

Evaluating pediatric electrocardiograms (ECGs) is challenging. Cardiologists showed variability in diagnosing left ventricular hypertrophy (LVH) and right ventricular hypertrophy (RVH), even with clinical information, complicating their use as a gold standard.

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Area of Science:

  • Pediatric Cardiology
  • Medical Diagnostics
  • Electrocardiography

Background:

  • Physicians' diagnoses are the benchmark for evaluating automated electrocardiogram (ECG) interpretation systems.
  • This study assessed inter- and intraobserver variability in pediatric ECG interpretation by two cardiologists.

Purpose of the Study:

  • To examine the variability in ECG reporting between and within two pediatric cardiologists.
  • To evaluate the impact of clinical information on diagnostic agreement for LVH and RVH.

Main Methods:

  • Two pediatric cardiologists independently interpreted 984 pediatric ECGs.
  • Clinical indications were provided for 664 ECGs; 320 were interpreted 'blind'.
  • ECGs diagnosed with LVH or RVH were re-interpreted 'blind' to assess intraobserver agreement.

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Main Results:

  • Clinical information improved inter-cardiologist agreement for LVH (kappa from 0.44 to 0.52) but not RVH (kappa from 0.66 to 0.63).
  • One cardiologist was more consistent in diagnosing RVH, while the other was more consistent for LVH.
  • Significant inter- and intraobserver variability exists in pediatric ECG interpretation.

Conclusions:

  • Cardiologists' diagnoses present challenges when used as a gold standard for evaluating pediatric ECG analysis programs.
  • Variability in interpretation highlights the need for standardized protocols and advanced diagnostic tools.