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.
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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
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Stephen M. Salerno, Patrick C. Alguire, Herbert S. Waxman. Competency in Interpretation of 12-Lead Electrocardiograms: A Summary and Appraisal of Published Evidence. Ann Intern Med. 2003;138:751–760. doi: 10.7326/0003-4819-138-9-200305060-00013
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Published: Ann Intern Med. 2003;138(9):751-760.
Cardiac Diagnosis and Imaging, Cardiology.
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