Is nurse interpretation of the ECG QRS width reliable?

Area of Science:

• Emergency Medicine
• Clinical Toxicology
• Cardiology

Background:

• Electrocardiogram (ECG) interpretation is crucial for managing sodium channel antagonist overdose.
• Poison centers often depend on verbal ECG reports from nurses.
• The accuracy of nurse-obtained ECG data has not been previously studied.

Purpose of the Study:

• To assess nurses' ability to recognize and measure widened QRS complexes on ECGs.
• To evaluate the impact of different instructional methods on ECG interpretation accuracy.
• To determine the reliability of verbal ECG data in sodium channel poisoning cases.

Main Methods:

• Prospective study involving 36 nurses interpreting 12 ECGs (normal and wide QRS).
• Nurses determined QRS width and measured duration.
• Three groups received different instructions: visual, verbal, or none.

Main Results:

• Nurses correctly identified wide QRS complexes 77% of the time.
• Accurate measurement of QRS duration was achieved by only 44% of nurses.
• No significant improvement in accuracy was observed with visual or verbal instructions.

Conclusions:

• Nurses demonstrate a moderate ability to identify wide QRS complexes but significant difficulty in accurate measurement.
• Current verbal ECG reporting by nurses may be insufficient for precise clinical assessment in sodium channel antagonist overdose.
• Further training or improved methods for ECG data acquisition are needed.