The Emergency Department Versus the Computer: Which Is the Better Electrocardiographer?

Snyder, Christopher S.; Fenrich, Arnold L.; Friedman, RA; Macias, Charles G.; O’Reilly, Kristin; Kertesz, Naomi J.

doi:10.1007/s00246-002-0332-z

Cited by 33 publications

(29 citation statements)

References 10 publications

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“…Ironically, a computer makes most of the mistakes in the most serious clinical situations. This was demonstrated elegantly while comparing ECG-diagnostic skills of computer versus an emergency room physician [11]. All ECGs were divided into four categories according to their clinical significance.…”

Section: Discussionmentioning

confidence: 99%

Common errors in computer electrocardiogram interpretation

Guglin

Thatai

2006

International Journal of Cardiology

108

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Section: Discussionmentioning

confidence: 99%

Common errors in computer electrocardiogram interpretation

Guglin

Thatai

2006

International Journal of Cardiology

108

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“…128,129 Eight studies either found no effect or equivocal effect of the use of computerized ECG interpretation on diagnostic accuracy (LOE 1 111,130 -132 ; LOE D5 [133][134][135][136] ). Two studies found evidence that the use of computerized ECG interpretation decreased diagnostic accuracy (LOE D1).…”

Section: Consensus On Sciencementioning

confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

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These experts reviewed 25 topics related to the acute initial management of acute coronary syndrome (ACS), which was further categorized as unstable angina, non-ST-elevation MI (UA/NSTEMI) and ST-elevation MI (STEMI). Topics were identified based on previous recommendations, emerging science, and clinical importance, using an iterative writing process involving all Task Force members. The Task Force reviewed the evidence specifically related to diagnosis and treatment of ACS in the out-ofhospital setting and the first hours of care in the in-hospital setting, typically in the emergency department (ED). The evidence review took place over several years, with ongoing refinement of recommendations being made as new evidence was published. The purpose of the review was to generate current, evidence-based treatment recommendations for healthcare providers who serve as the initial point of contact for patients with signs and symptoms suggestive of ACS.The following is a summary of the most important changes in recommendations for diagnosis and treatment of ACS since the last ILCOR review in 2005. 1,2• The history and physical examination, initial ECG, and initial serum biomarkers, even when used in combination, cannot be used to reliably exclude ACS in the prehospital and ED settings.• In contrast, chest pain observation protocols are useful in identifying patients with suspected ACS and patients who require admission or may be referred for provocative testing for coronary artery disease (CAD) to identify reversible ischemia. Such strategies also reduce cost by reducing unnecessary hospital admissions and improve patient safety through more accurate identification of NSTEMI and STEMI.• The acquisition of a prehospital 12-lead ECG is essential for identification of STEMI patients before hospital arrival and should be used in conjunction with pre-arrival hospital notification and concurrent activation of the catheter laboratory.• Nonphysicians can be trained to independently interpret 12-lead ECGs for the purpose of identifying patients with STEMI, provided that appropriate and reliable STEMI criteria are used. This skill is of particular value in the prehospital setting where paramedics may independently identify STEMI, thus mitigating over-reliance on ECG transmission.• Computer-assisted ECG interpretation can be used to increase diagnostic accuracy of STEMI diagnosis when used alone or in combination with ECG interpretation by a trained healthcare provider.• STEMI systems of care can be implemented to improve the time to treatment. The following measures have been shown to reduce the time to primary percutaneous coronary intervention (PPCI): institutional commitment, use of a team-based approach, arranging single-call activation of the catheterization laboratory by the emergency physician or prehospital provider, requiring the catheterization laboratory to be ready in 20 minutes, having an experienced cardiologist always available, and providing real-time data feedback.• Intravenous (IV) ␤-blockers should not be give...

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“…5,6 We hypothesized that triage ECGs interpreted as "normal" by computer analysis would not have immediate clinical significance and therefore would not warrant immediate EP review.…”

mentioning

confidence: 99%

Safety of Computer Interpretation of Normal Triage Electrocardiograms

Hughes

Lewis

Katz

et al. 2017

Academic Emergency Medicine

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ObjectivesFrequent interruptions within the emergency department may lead to errors that negatively impact patient care. The immediate review of electrocardiograms (ECGs) obtained from triage patients is one source of interruption. Limiting triage ECGs requiring immediate attending review to those interpreted by the computer as abnormal may be one way to reduce interruption. We hypothesize that triage ECGs interpreted by the computer as “normal ECG” are unlikely to have clinical significance that would affect triage care.MethodsAll triage ECGs performed at the University of North Carolina were collected between November 14, 2014, and March 3, 2015, according to a standard nursing triage protocol using GE machines running Marquette 12SL software. Triage ECGs with a computer interpretation of “normal ECG” were compared to an attending cardiologist's final interpretation. Triage ECGs for which the cardiologist's interpretation differed from the computer interpretation of normal ECG were presented to two emergency physicians (EPs) blinded to the goals of the study. The physicians were asked to evaluate the ECG for clinical significance. Clinical significance was defined as any change from normal that would alter triage care. Triage ECGs were considered true negatives if either the cardiologist agreed with the normal computer interpretation or if both EPs agreed that the ECG did not show clinical significance.ResultsA total of 855 triage ECGs were collected over 16 weeks. A total of 222 (26%) were interpreted by the computer as normal. The negative predictive value for a triage ECGs interpreted by the computer as “normal” was calculated to be 99% (95% confidence interval = 97% to 99%). Of the ECGs with a computer interpretation of normal ECG, 13 had an interpretation by an attending cardiologist other than normal. Two attending EPs reviewed these triage ECGs. One of the 13 ECGs was found to have clinical significance that would alter triage care by one of the EPs. The stated triage intervention was “bed immediately.”ConclusionsOur data suggest that triage ECGs identified by the computer as normal are unlikely to have clinical significance that would change triage care. Eliminating physician review of triage ECGs with a computer interpretation of normal may be a safe way to improve patient care by decreasing physician interruptions.

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The Emergency Department Versus the Computer: Which Is the Better Electrocardiographer?

Cited by 33 publications

References 10 publications

Common errors in computer electrocardiogram interpretation

Common errors in computer electrocardiogram interpretation

Part 9: Acute Coronary Syndromes

Safety of Computer Interpretation of Normal Triage Electrocardiograms

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