Non-conscious detection of ST-segment elevation during physician ECG interpretation

Area of Science:

• Cardiology
• Medical Imaging
• Cognitive Neuroscience

Background:

• Electrocardiograms (ECGs) are crucial for diagnosing ST-elevation myocardial infarctions (STEMIs).
• Diagnostic errors in STEMI interpretation can lead to delayed treatment and adverse patient outcomes.
• Understanding the cognitive processes underlying ECG interpretation is essential for improving accuracy.

Purpose of the Study:

• To investigate the role of non-conscious cognitive processes in the detection of STEMIs on ECGs.
• To determine if physicians' eye movements reveal subconscious detection of missed STEMIs.
• To explore the potential of eye-tracking technology in enhancing ECG interpretation.

Main Methods:

• Eight experienced physicians interpreted 90 ECGs (45 STEMI, 45 Normal) without clinical context.
• Eye movements were recorded during ECG interpretation using eye-tracking technology.
• Physicians consciously marked recognized or considered STEMIs.

Main Results:

• Physicians missed 18% of STEMIs.
• Eye-tracking data showed significantly longer viewing durations (P=0.02) and increased transitions (P=0.02) to ECG leads with missed STEMIs compared to normal leads.
• More frequent fixations (P=0.02) were observed on leads with missed STEMIs.

Conclusions:

• Non-conscious cognitive processes contribute to STEMI detection, even when not consciously recognized.
• The findings suggest a holistic, non-conscious mechanism for identifying culprit lesion sites on ECGs.
• Eye-tracking technology holds promise for improving ECG interpretation accuracy and reducing diagnostic errors in clinical practice.