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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.
Insights
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.
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.
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.
Background:
Physicians' diagnoses are often used as the gold standard for evaluating computer electrocardiogram (ECG) interpretation programs. As part of a larger study to evaluate the Glasgow pediatric ECG analysis program, inter- and intraobserver variability in the ECG reporting of two pediatric cardiologists was examined.
Methods:
The ECGs of 984 children were sent for reporting independently by two cardiologists with all identifying information except age and sex removed. Three hundred twenty ECGs had no clinical indication available, and they were thus reported "blind." For 664 ECGs, the clinical indication was known and included with the ECG trace. All ECGs reported as right ventricular hypertrophy (RVH) or left ventricular hypertrophy (LVH) were returned to the cardiologists without their knowledge for reporting a second time "blind" as to the clinical indication.
Results:
When the cardiologists' reports were compared with each other, the provision of clinical information led to greater agreement between them for the diagnosis of LVH (kappa increased from 0.44 to 0.52) but did not substantially affect their agreement in diagnosing RVH (kappa fell from 0.66 to 0.63). Intraindividual comparisons in 166 ECGs revealed that one cardiologist was more consistent in diagnosing RVH and the other more consistent in diagnosing LVH.
Conclusions:
This study has demonstrated the difficulties in using cardiologists' diagnoses as the gold standard with which to evaluate pediatric ECGs.
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