Diagnostic Reasoning for ST-Segment Elevation Myocardial Infarction (STEMI) Interpretation Is Preserved Despite
Journal of Graduate Medical Education
|July 29, 2015
Summary
Circadian disruption and fatigue did not impair emergency medicine residents' diagnostic accuracy for ST-segment elevation myocardial infarction (STEMI) on electrocardiogram (ECG) interpretation, despite increased sleepiness.
Area of Science:
- Medical Education
- Cardiology
- Sleep Medicine
Background:
- Fatigue and sleepiness are known contributors to medical errors.
- The impact of circadian disruption and fatigue on diagnostic reasoning remains under-explored.
Purpose of the Study:
- To evaluate if circadian disruption and fatigue affect emergency medicine (EM) residents' clinical decision-making based on electrocardiogram (ECG) interpretation.
- Assessing the accuracy of cardiac catheterization laboratory activation (CLA) decisions in EM residents under varying fatigue levels.
Main Methods:
- Senior EM residents completed fatigue questionnaires and an ECG test packet.
- Participants interpreted ECGs for ST-segment elevation myocardial infarction (STEMI) and STEMI mimics, deciding on CLA.
- Accuracy of CLA decisions and diagnostic confidence were compared between daytime and overnight testing.
Main Results:
- Twenty-three residents participated, showing increased sleepiness and fatigue overnight.
- No significant difference was found in the accuracy of CLA decisions between daytime and overnight testing (70% vs. 70%).
- Overcall and undercall rates, diagnostic confidence, and confidence in CLA decisions were also not significantly different.
Conclusions:
- Senior EM residents maintained diagnostic accuracy for ECG interpretation despite measurable fatigue.
- Circadian disruption and fatigue did not negatively impact critical decisions regarding STEMI management in this cohort.
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