Article review: EKG interpretation by the computer

What is your reading of this EKG?


Having a computer interpretation printed on EKGs is always a nice backup when reading EKGs. In my experience, the reading is a useful adjunct but it sometimes "overcalls" ST elevation MIs. It is great, though, in picking up subtle pacemaker spikes and calculating QTc intervals.

In this publication, the authors ask - Do erroneous computer interpretations of EKGs affect resident decision making?

In this study, 105 emergency medicine and internal medicine residents were presented with a paper case of a patient with chest pain. Each resident randomly picked up 1 of 2 EKGs (shown above). One EKG had no computer interpretation. The other had an ERRONEOUS computer interpretation, which read:

ST ELEVATION CONSIDER INFERIOR INJURY OR ACUTE INFARCT
** ** ** ** * ACUTE MI * ** ** ** **

Each resident was asked categorize the EKG reading into one of the 3 groups:
  • Diagnostic of ischemia or infarct
  • Nondiagnostic (correct answer)
  • Normal
The resident was also asked to provide their recommendation:
  • Urgent revascularization
  • Maximal medical treatment for ischemia
  • Minimal medical treatment for ischemia (correct answer)
Results
(Click to enlarge image.)

The distribution of EKG readings (diagnostic vs nondiagnostic vs normal) between the 2 resident groups were equivalent.

Residents who received EKGs with an erroneous computer interpretation were more likely to recommend urgent revascularization than those who had no computer interpretation (30% vs 10%, p=0.01).

More specifically, in the subgroup of residents who read the EKG as "diagnostic of ischemia/infarct" (n=48), the residents who had erroneously computer-interpreted EKGs were more likely to recommend urgent revascularization than the other group of residents (54% vs 25%, p=0.048).

Bottom Line
Having an erroneous computer interpretation of the EKG did not influence the residents' READING of the EKG. It did, however, influence their MANAGEMENT recommendations. In this case where the computer interpretation read "acute MI", residents were more swayed towards a more aggressive plan.

Thus, beware the EKG computer interpretation.

In the end, the patient with the EKG above had a normal cardiac catheterization. She had pericarditis.

Reference
Southern WN, Arnsten JH. The Effect of Erroneous Computer Interpretation of ECGs on Resident Decision Making. Med Decis Making. 2009;29:372–6.
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