Reliability of electrocardiogram interpretation in critically ill patients
Wendy Lim1, Ismael Qushmaq, Deborah J Cook
1Medicine & Clinical Epidemiology, McMaster University, Hamilton, Ontario, Canada.
Critical Care Medicine
|March 25, 2006
Summary
Electrocardiogram (ECG) interpretation for myocardial ischemia in critically ill patients showed moderate reliability. Knowledge of troponin values significantly improved interrater reliability for diagnosing ischemia or infarction.
Area of Science:
- Critical Care Medicine
- Cardiology
- Diagnostic Accuracy
Background:
- Electrocardiogram (ECG) interpretation is crucial for diagnosing acute cardiac events in critically ill patients.
- Reliability of ECG interpretation in intensive care units (ICUs) can be affected by patient acuity and confounding factors.
- The impact of biochemical markers, such as cardiac troponins, on ECG interpretation reliability is not well-established.
Purpose of the Study:
- To evaluate the intrarater and interrater reliability of ECG interpretation in critically ill patients.
- To determine the effect of knowledge of cardiac troponin values on the reliability of ECG interpretation.
Main Methods:
- Prospective cohort study conducted in a 15-bed medical-surgical ICU.
- Consecutive adult patients admitted over a 2-month period.
- Independent interpretation of 12-lead ECGs by two raters, initially blinded to troponin levels, then reinterpreted unblinded.
Main Results:
- Intrarater reliability for ischemia/infarction ranged from fair to moderate.
- Interrater reliability for ischemia/infarction was slight when blinded to troponin levels but increased significantly to moderate when unblinded (p=0.004).
- High reliability was observed for specific ECG changes like left bundle branch block, while T-wave flattening showed low reliability.
Conclusions:
- ECG interpretation for myocardial ischemia/infarction in critically ill patients has moderate reliability at best.
- Knowledge of troponin values significantly enhances interrater reliability for diagnosing myocardial ischemia/infarction.
- Further research is needed to optimize diagnostic methods and assess reliability in critically ill populations.
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