Pediatric Cardiology

, Volume 24, Issue 4, pp 364–368 | Cite as

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

  • C. S. Snyder
  • A. L. Fenrich
  • R. A. Friedman
  • C. Macias
  • K. O’Reilly
  • N. J. Kertesz
Original Article

Abstract

Electrocardiograms (ECGs) are frequently ordered in the pediatric emergency department (ED). Pediatric cardiologists are generally not asked to interpret every ECG; thus, ED patient management is often guided by the ED physicians’ ECG interpretation. The objective of this study was to analyze the accuracy of ECG interpretation by ED physicians and a computer-generated interpretation and compare the two. A 12-month prospective study was performed in a pediatric ED. All patients (<22 years) who had an ECG in the ED were included. The ED physicians and the computer interpretation were compared to a reference standard. Each electrocardiographic diagnosis, as well as the ECG as a whole, was assigned to one of the following predetermined classes: I, normal sinus rhythm; II, minimal clinical significance; III, indeterminate clinical significance; IV, those of definite clinical significance. Both groups correctly interpreted all normal (class I) ECGs. The computer correctly interpreted approximately 75% of the class II and class III ECGs, whereas the ED physicians correctly interpreted 36% of both groups. For the class IV ECGs, both the computer and the ED physicians performed poorly, correctly interpreting just 14% and 28%, respectively. The computer proved to be more accurate than the ED physicians in interpreting ECGs of less than critical significance (classes II and III), but neither group was able to correctly interpret even a simple majority of the most significant abnormalities (class IV). We speculate that distributing the computer-generated interpretation to the ED physicians and formal review of all ED ECGs by a skilled interpreter may decrease the number of missed diagnoses.

Keywords

Electrocardiogram Emergency department 

References

  1. 1.
    Bell, MR, Kozak, RJ 1996Seizures and the long-QT syndrome.Ann Emergency Med28556560Google Scholar
  2. 2.
    Bradley, T, Dixon, J, Easthope, R 1999Unexplained fainting, near drowning and unusual seizures in childhood: screening for long QT syndrome in New Zealand families.NZ Med J112299302Google Scholar
  3. 3.
    Davis, AM, Wilkinson, JL 1998The long QT syndrome and seizures in childhood.J Paediatr Child Health34410411CrossRefPubMedGoogle Scholar
  4. 4.
    Fouron, J, Chicoine, R 1971ECG changes in fetal imipramine (Tofranil) intoxication.Pediatrics48777781PubMedGoogle Scholar
  5. 5.
    Harris, EM, Knapp, JF, Sharma, V 1992The Romano–Ward syndrome: a case presenting as near drowning with a clinical review.Pediatr Emergency Care8272275Google Scholar
  6. 6.
    Horton, LA, Mosee, S, Brenner, J 1994Use of the electrocardiogram in a pediatric emergency department.Arch Pediatr Adolesc Med148184188PubMedGoogle Scholar
  7. 7.
    Ludomirsky, A, Klein, H, Kaplinsky, E 1982QT prolongation and polymorphous ventricular arrhythmias associated with organophorous insecticide poisoning.Am J Cardiol4916541658PubMedGoogle Scholar
  8. 8.
    Pilapil, VR, Watson, DG 1970The electrocardiogram in hyperthyroid children.Am J Dis Child119245248PubMedGoogle Scholar
  9. 9.
    Snoey, ER, Housset, B, Guyon, P,  et al. 1994Analysis of emergency department interpretation of electrocardiograms.J Accidental Emergency Med11149153Google Scholar
  10. 10.
    Surawicz, B 1967Relationship between the electrocardiogram and electrolytes.Am Heart J73814825PubMedGoogle Scholar
  11. 11.
    Todd, K, Hoffman, J, Morgan, M 1996Effect of cardiologist ECG review on emergency department practice.Ann Emergency Med271621Google Scholar
  12. 12.
    Woolley, D, Henck, M, Luck, J 1992Comparison of electrocardiogram interpretations by family physicians, a computer, and a cardiology service.J Family Practice34428432Google Scholar

Copyright information

© Springer-Verlag 2002

Authors and Affiliations

  • C. S. Snyder
    • 1
  • A. L. Fenrich
    • 1
  • R. A. Friedman
    • 1
  • C. Macias
    • 2
  • K. O’Reilly
    • 1
  • N. J. Kertesz
    • 1
  1. 1.Division of Pediatric CardiologyTexas Children’s Hospital, Baylor College of Medicine, 6621 Fannin, MC2-2800, Houston TX 77030USA
  2. 2.Division of Emergency MedicineTexas Children’s Hospital, Baylor College of Medicine, 6621 Fannin, MC2-2800, Houston, TX 77030USA

Personalised recommendations