Stephen M. Salerno, MD, MPH; Patrick C. Alguire, MD; Herbert S. Waxman, MD
Drs. Alguire and Salerno dedicate this article to Herbert Waxman, MD, a friend and colleague whose vision, leadership, and friendship will be missed. Dr. Waxman, who served as Senior Vice President for Medical Knowledge and Education at the American College of Physicians, died on 15 February 2003.
Disclaimer: The opinions or assertions presented are the private views of the authors and are not to be construed as official or as reflecting those of the Department of the Army or Department of Defense.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Customer Service, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, email@example.com.
Current Author Addresses: Dr. Salerno: Department of Medicine (MCHK-DM), Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859.
Dr. Alguire: Medical Knowledge and Education Division, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.
There have been many proposals for objective standards designed to optimize training, testing, and maintaining competency in interpretation of electrocardiograms (ECGs). However, most of these recommendations are consensus based and are not derived from clinical trials that include patient outcomes.
To critically review the available data on training, accuracy, and outcomes of computer and physician interpretation of 12-lead resting ECGs.
English-language articles were retrieved by searching MEDLINE (1966 to 2002), EMBASE (1974 to 2002), and the Cochrane Controlled Trials Register (19752002). The references in articles selected for analysis were also reviewed for relevance.
All articles on training, accuracy, and outcomes of ECG interpretations were analyzed.
Study design and results were summarized in evidence tables. Information on physician interpretation compared to a gold standard, typically a consensus panel of expert electrocardiographers, was extracted. The clinical context of and outcomes related to the ECG interpretation were obtained whenever possible.
Physicians of all specialties and levels of training, as well as computer software for interpreting ECGs, frequently made errors in interpreting ECGs when compared to expert electrocardiographers. There was also substantial disagreement on interpretations among cardiologists. Adverse patient outcomes occurred infrequently when ECGs were incorrectly interpreted.
There is no evidence-based minimum number of ECG interpretations that is ideal for attaining or maintaining competency in ECG interpretation skills. Further research is needed to clarify the optimal way to build and maintain ECG interpretation skills based on patient outcomes.
Table 1. Electrocardiogram Interpretation Studies with Clinical Outcomes
Table 2. Electrocardiogram Interpretation Studies Comparing Computer and Physician Interpretation
Table 3. Electrocardiogram Interpretation Studies without Outcomes Related to Interpretation Errors
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Salerno SM, Alguire PC, Waxman HS. Competency in Interpretation of 12-Lead Electrocardiograms: A Summary and Appraisal of Published Evidence. Ann Intern Med. ;138:751–760. doi: 10.7326/0003-4819-138-9-200305060-00013
Download citation file:
Published: Ann Intern Med. 2003;138(9):751-760.
Cardiac Diagnosis and Imaging, Cardiology.
Results provided by:
Copyright © 2019 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use