Non-conscious detection of ST-segment elevation during physician ECG interpretation
Gregory J DiGirolamo1, Nikolaos Kakouros2, Federico Sorcini3
1Department of Psychology, College of the Holy Cross, Worcester, MA, United States of America; Department of Radiology, UMass Chan Medical School, Worcester, MA, United States of America.
Objective:
To investigate errors in the assessment of ST-elevation (STEs) myocardial infarctions on ECGs to determine if non-conscious processes successfully detect missed STEs, as evidenced by changes in how long and often physicians look at leads with STEs.
Materials And Method:
Eight experienced physicians interpreted 90 ECGs (45 STEs, 45 Normal) while eye movements were recorded. Physicians marked consciously recognized or considered STEs. No clinical context was provided.
Results:
Physicians missed 18% of STEs. Eye-tracking showed longer (P = 0.02), more frequent (P = 0.02), and increased transitions (P = 0.02) to "missed" STE leads compared to Normal ECG leads.
Discussion:
Non-conscious detection of STEs, including inter‑lead relationships, despite a lack of conscious recognition, suggests a sophisticated mechanism of wholistic detection, including culprit lesion sites by non-conscious processes.
Conclusion:
Non-conscious detection of STEs supports non-conscious detection processing in medicine leading to more success than can be tracked by conscious report. Eye-tracking could enhance ECG interpretation and reduce diagnostic errors.
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