The effect of clinical history on accuracy of electrocardiograph interpretation among doctors working in emergency departments

Cruz, Monique F; Edwards, James; Dinh, Michael; Barnes, Elizabeth H

doi:10.5694/mja11.11598

Cited by 15 publications

(10 citation statements)

References 22 publications

(68 reference statements)

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“…A false-negative (FN) diagnosis due to a perception or cognitive error is a recognised problem [1]. Evidence from earlier eye-tracking experiments using chest images reveals that most radiologists do not follow a systematic search strategy [2,3], and interpretation of these images can be influenced significantly by the clinical information provided by referrers [4][5][6][7]. Clinical information is provided as a guide for patient diagnosis and can be disease specific, symptom specific, location specific or a combination of these.…”

Section: Introductionmentioning

confidence: 99%

Does Expectation of Abnormality Affect the Search Pattern of Radiologists When Looking for Pulmonary Nodules?

et al. 2016

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This experiment investigated whether there might be an effect on the visual search strategy of radiologists during image interpretation of the same adult chest radiographs when given different clinical information. Each of 17 experienced radiologists was asked to interpret a set of 57 (10 abnormal) posteroanterior chest images to identify the presence of pulmonary lesions using differing clinical information (leading to unknown, low and high expectations of prevalence). Eye position metrics (search time, dwell time and time to first fixation) were compared for normal and abnormal images, as well as between conditions. For all images, there was a significantly longer search time at high prevalence expectation compared to low prevalence expectation (W = 75.19, P = <0.0001). Mann-Whitney analysis of the abnormal images demonstrated that the dwell time on correctly identified lesions was significantly shorter at low prevalence expectation compared to both unknown (U = 364.5, P = 0.02) and high prevalence expectation (U = 397.0, P = 0.0002). Visual search patterns of radiologists appear to be affected by changing a priori information where such information fosters an expectation of abnormality.

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Section: Introductionmentioning

confidence: 99%

Does Expectation of Abnormality Affect the Search Pattern of Radiologists When Looking for Pulmonary Nodules?

et al. 2016

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“…A simultaneous video‐surface or intracranial EEG recording is far more accurate . ECG interpretations are also susceptible to such diagnostic errors, due to unreliable or inaccurate clinical history .…”

Section: Impact Of Cognitive Factors On Image‐based Diagnosesmentioning

confidence: 99%

“…Elmore in 1997 and Griscom in 2002 had suggested this reversal of the usual diagnostic order by a first agnostic examination of images without access to referring clinical question, and then a subsequent interpretation incorporating the history . In cases where changing this sequence is not possible, at least a verification for accuracy of the history supplied before the interpretation is highly desirable . Adoption of this agnostic first reading solution does not seem overly burdensome, although experimental proof for its utility awaits future research.…”

Section: Possible Solutionsmentioning

confidence: 99%

Diagnosing Crime and Diagnosing Disease‐II: Visual Pattern Perception and Diagnostic Accuracy

Satya‐Murti¹,

Lockhart²

2018

Journal of Forensic Sciences

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Previously, we reviewed how general cognitive processes might be susceptible to bias across both forensic and clinical fields, and how interdisciplinary comparisons could reduce error. We discuss several examples of clinical tasks which are heavily dependent on visual processing, comparing them to eyewitness identification (EI). We review the "constructive" nature of visual processing, and how contextual factors influence both medical experts and witnesses in decision making and recall. Overall, studies suggest common cognitive factors uniting these visual tasks, in both their strengths and shortcomings. Recently forensic sciences have advocated reducing errors by identifying and controlling nonrelevant information. Such efforts could effectively assist medical diagnosis. We suggest potential remedies for cognitive bias in these tasks. These can generalize across the clinical and forensic domains, including controlling the sequencing of contextual factors. One solution is an agnostic primary reading before incorporation of a complete history and interpretation.

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“…An observational study on how history can bias electrocardiograph interpretation in an emergency department is an excellent model for similar studies in the Neurosciences. 107,108 Awareness of our biases may minimize diagnostic errors. We need further insights into clinical decision-making, so that errors can be minimized.…”

Section: Diagnosis and Investigationsmentioning

confidence: 99%

The Evidence-based Medicine Paradigm: Where are We 20 Years Later? Part 1

Seshia

Young²

2013

Can. J. Neurol. Sci.

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A "new approach to teaching the practice of Medicine" described as a "paradigm shift," and called "evidence-based medicine" (EBM), was first discussed in 1992. 1 The paradigm was meant to replace an "authoritarian (opinion-based)" attitude in health-care with an "authoritative (evidence-based)" one. 1,2 This two part narrative review addresses some issues at the core of EBM. These include hierarchical levels, the randomized controlled trial (RCT), systematic (including Cochrane) reviews (SRs) and statistical methods to assess evidence. The objective is not only to inform but also to facilitate continuing dialogue on a paradigm that is now embedded in the teaching, practice, research, writings and management of health-care, 2-5 Neurosciences included. 6-8 METHODSThe principles out-lined in Straus et al, 2 were used to seek references pertinent to EBM, first through PubMed. The initial search term "Evidence-based Medicine" yielded 79,600 results. Limits were then placed: human; guidelines; reviews; systematic reviews; meta-analyses, and editorial confined to the English language. Additional searches were made using Medical Subject Headings (MeSH), "randomized controlled trials," "confidence intervals," "number needed to treat," "CONSORT," "levels of ABSTRACT:The evidence-based medicine (EBM) paradigm, introduced in 1992, has had a major and positive impact on all aspects of health care. However, widespread use has also uncovered some limitations; these are discussed from the perspectives of two clinicians in this, the first of a two part narrative review. For example, there are credible reservations about the validity of hierarchical levels of evidence, a core element of the EBM paradigm. In addition, potential and actual methodological and statistical deficiencies have been identified, not only in many published randomized controlled trials but also in systematic reviews, both rated highly for evidence in EBM classifications. Ethical violations compromise reliability of some data. Clinicians need to be conscious of potential limitations in some of the cornerstones of the EBM paradigm, and to deficiencies in the literature. RÉSUMÉ: Paradigme de la médecine fondée sur des preuves : où en sommes-nous 20 ans plus tard? Première partie. Le paradigme de la médecine fondée sur des données probantes (MFDP) introduit en 1992 a eu un impact positif majeur sur tous les aspects des soins de santé. Cependant, son utilisation répandue a également mis au jour certaines limites. Nous discutons de ces limites du point de vue de deux cliniciens dans la première partie de cet examen narratif. Il existe, par exemple, des réserves crédibles concernant la validité des niveaux hiérarchiques de preuves, un élément clé du paradigme de la MFDP. De plus, des lacunes potentielles et réelles dans la méthodologie et l'analyse statistique ont été identifiées, non seulement dans plusieurs essais cliniques randomisés qui ont été publiés, mais également dans les revues systématiques, deux sources de données très prisées pour établir les classific...

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The effect of clinical history on accuracy of electrocardiograph interpretation among doctors working in emergency departments

Abstract: Conclusion: Bias in clinical history significantly influenced the accuracy of ECG interpretation. Strategies that reduce the detrimental impact of cognitive bias and improved ECG training for doctors are recommended.

Cited by 15 publications

References 22 publications

Does Expectation of Abnormality Affect the Search Pattern of Radiologists When Looking for Pulmonary Nodules?

Does Expectation of Abnormality Affect the Search Pattern of Radiologists When Looking for Pulmonary Nodules?

Diagnosing Crime and Diagnosing Disease‐II: Visual Pattern Perception and Diagnostic Accuracy

The Evidence-based Medicine Paradigm: Where are We 20 Years Later? Part 1

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