Accuracy of Electro Cardiogram (ECG) Interpretation and need for ECG Audit in Emergency Department, A prospective observational study from a tertiary care teaching hospital

Abstract

In spite of much recent advancement, 12 lead electro cardiogram (ECG) is still the most relied upon tool for diagnosis of cardiac emergencies in the emergency departments, especially in resource poor settings. Studies on accuracy of ECG interpretations, their likely impact in the emergency departments are scarce from India. Objective:To assess the accuracy of the ECG interpretation by CMO/resident doctors and emergency physicians, in emergency department of a tertiary care teaching hospital in south India. Methodology:The study was a prospective observational study conducted in the emergency medicine department of tertiary care teaching hospital. ECG interpretations of CMO/resident doctor and emergency physicians are compared against the blinded, gold standard interpretation by a cardiologist panel. Results:A total of 2857 ECGs of the patients presenting with chest pain were analyzed. The overall concordance as assessed by mean pair agreement index (MPAI) was higher for emergency physician (MPAI=83.75%, Kappa statistic =0.50), compared to CMO/resident doctor (MPAI=75.95%, Kappa statistic =0.48). The concordance rate for abnormal ECG, as assessed by sensitivity of was only 67.2% for CMO/ resident doctor and was 78.3% for emergency physician. The concordance rate for normal ECGs, as assessed by specificity was 81.5% and 87.2% respectively for both the groups. Conclusions:ECG interpretation skills for both normal and abnormal ECGs are better in emergency physicians, compared to CMO/resident doctors and are better for normal ECGs, compared to abnormal ECGs. Many life threatening emergencies, which need immediate intervention, are being missed.