Diagnosis of right bundle branch block: a concordance study
M Alventosa-Zaidin1, G Pera2, C Roca Saumell3
1Bon Pastor, Primary Healthcare Center, Catalan Health Institute, Barcelona, Catalonia, Spain. malvenza83@gmail.com.
Insights
Primary care physicians and cardiologists showed high agreement in diagnosing right bundle branch block (RBBB). Concordance was excellent for complete RBBB and good for incomplete RBBB, highlighting the reliability of ECG interpretation in primary care.
Area of Science:
- Cardiology
- Medical Diagnostics
- Primary Care Medicine
Background:
- Right bundle branch block (RBBB) is a common electrocardiographic abnormality frequently detected in primary care settings.
- Accurate interpretation of electrocardiograms (ECGs) is crucial for managing RBBB, often identified in asymptomatic patients.
- This study addresses the need for reliable RBBB diagnosis at the primary care level.
Purpose of the Study:
- To assess the diagnostic concordance of incomplete and complete right bundle branch block (RBBB) between primary care physicians and a cardiologist.
- To evaluate the reliability of ECG interpretation for RBBB in a primary care context.
Main Methods:
- A retrospective cohort study involving 160 patients diagnosed with RBBB.
- Four primary care physicians and one cardiologist specialized in ECG interpretation participated.
- Interobserver agreement was measured using Fleiss' kappa (k) for incomplete and complete RBBB diagnoses.
Main Results:
- High interobserver agreement was observed among all five specialists for both RBBB types (k=0.71 for incomplete, k=0.93 for complete).
- Agreement was even higher among only the primary care physicians (k=0.85 for incomplete, k=0.96 for complete).
- Diagnostic variability was notably greater for incomplete RBBB compared to complete RBBB.
Conclusions:
- Physicians specialized in ECG interpretation, including primary care physicians, demonstrate very good interobserver agreement in diagnosing RBBB.
- The diagnosis of incomplete RBBB presents slightly more variability than complete RBBB among specialists.
- Findings support the accuracy of RBBB diagnosis within primary care settings with appropriate expertise.
Background:
Right bundle branch block is one of the most common electrocardiographic abnormalities. Most cases of right bundle branch block are detected in asymptomatic patients in primary care, so a correct interpretation of electrocardiograms (ECGs) at this level is necessary. The objective of this research is to determine the degree of concordance in the diagnosis of incomplete and complete right bundle branch block between four primary care researchers and a cardiologist.
Methods:
The research design is a retrospective cohort study of patients over 18 years of ages of patients over 18 years of ages who underwent an ECG for any reason and were diagnosed with right bundle branch block by their physician. The physicians participating, 4 primary care researchers and a cardiologist were specialized in interpreting electrocardiographic records. The diagnosis of incomplete and complete right bundle branch block was recorded and other secondary variables were analysed. In case of diagnostic discordance between the researchers, the ECGs were reviewed by an expert cardiologist, who interpreted them, established the diagnosis and analysed the possible causes for the discrepancy.
Results:
We studied 160 patients diagnosed with right bundle branch block by their general practise. The patients had a mean age of 64.8 years and 54% of them were men. The concordance in the diagnosis of incomplete right bundle branch block showed a Fleiss' kappa index (k) of 0.71 among the five researchers and of 0.85 among only the primary care researchers. The k for complete right bundle branch block was 0.93 among the five researchers and 0.96 among only the primary care researchers.
Conclusion:
The interobserver agreement in the diagnosis of right bundle branch block performed by physicians specialized in ECG interpretation (primary care physicians and a cardiologist) was very good. The variability was greater for the diagnosis of incomplete right bundle branch block.
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