[Level of agreement in the interpretation of electrocardiograms]
A Moreno Castillo1, P Iglesias Gómez, E Arbesu Fernández
1Centro de Salud de Burgo de Osma, Soria.
Insights
General practitioners show acceptable electrocardiogram (ECG) diagnostic concordance with cardiologists, particularly for normal findings and rhythm disturbances. However, improvements are needed in diagnosing less common ECG abnormalities.
Area of Science:
- Cardiology
- General Medicine
- Diagnostic Accuracy
Background:
- Accurate interpretation of electrocardiograms (ECG) is crucial for timely diagnosis and management of cardiac conditions.
- Understanding the diagnostic concordance between general practitioners (GPs) and specialists is essential for optimizing patient care pathways.
Purpose of the Study:
- To evaluate the diagnostic agreement in ECG interpretation between GPs and a referral cardiologist.
- To identify specific diagnostic categories where concordance is high or low.
Main Methods:
- A crossover and descriptive study design was employed.
- Seven General Medicine consulting rooms participated.
- 318 ECGs were randomly distributed among GPs for interpretation over 11 months.
Main Results:
- Overall proportion of agreement (Po) exceeded 90% for most categories, except normality (76.5%).
- The overall Kappa (K) index for diagnostic concordance was 0.52, indicating moderate agreement.
- Concordance varied significantly by diagnostic category, with high K values for frequency disturbances (0.79) and lower values for auricular disturbances (0.07).
Conclusions:
- Overall diagnostic concordance for ECG interpretation between GPs and cardiologists is acceptable, especially for normality, rhythm, and frequency disturbances.
- Concordance was notably lower for ventricular conduction, repolarization, auricular-ventricular union, unspecific, and auricular disturbances.
- GPs tended to underdiagnose frequency and AV union disorders while overdiagnosing unspecific disorders, highlighting areas for targeted training and improvement.
Objective:
To evaluate diagnostic concordance in the interpretation of electrocardiograms (ECG) between general practitioners and a referral cardiologist.
Design:
Crossover and descriptive.
Setting:
Seven General Medicine consulting rooms at Burgo de Osma Health Centre.
Patients And Other Participants:
318 ECGs included and distributed at random among the doctors, from May 1992 to April 1993 (11 months). 28 were excluded for analysis.
Measurements And Main Results:
The proportion of agreement observed (Po) and the Kappa (K) index were obtained. Po was > 90% in all diagnostic categories, except normality (76.5%). Overall K was 0.52 (C.I. 95%: 0.50-0.54); K = 0.79 in disturbances in frequency; K = 0.52 in diagnosis of normality; K = 0.46 in disturbances of rhythm; K = 0.38 in ventricular conduction disorders; K = 0.36 in repolarisation disturbances; K = 0.32 for disorders of the auricular-ventricular union; K = 0.17 for unspecific disorders and K = 0.07 for auricular disturbances.
Conclusions:
Overall concordance is acceptable, as it is for normality and rhythm and frequency disturbances; for the remaining diagnostic categories it was light or ordinary. The Primary Care team (PCT) in comparison with the cardiologist underdiagnosed the frequency and a-v union disorders and overdiagnosed the unspecific disorders. The PCT must improve in their diagnoses of greater prevalence and low K value.
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