electrocardiogram interpretation in general practice
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Electrocardiogram interpretation in general practice. background. Common diagnostic test in GP (cardiac complaints) Difficulties of interpreting ECG: GP and residents > cardiologists More correct interpretation of ECG achieved by using interpretative ECG recorders. Objectives.

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Presentation Transcript
background
background
  • Common diagnostic test in GP (cardiac complaints)
  • Difficulties of interpreting ECG: GP and residents > cardiologists
  • More correct interpretation of ECG achieved by using interpretative ECG recorders
objectives
Objectives
  • To know the sensitivity and the specificity of ECG interpretation by both GPs and interpretative recorders.
methods
Methods
  • Setting: Ebeltoft, Denmark
  • Population: 902 ECGs (randomised aged 31-51 population)
  • Cross-sectional study
  • Gold standard: cardiologist ‘s interpretation
  • GPs not blinded to:
    • Results of interpretive ECG recorder
    • History and other clinical data
  • Cardiologist not blinded to:
    • Results of interpretive ECG recorder
methods1
Methods
  • 10 % of random sample of ECG viewed by an other cardiologist,
  • Statistic tool: SPSS,
  • McNemar’s test: sensitivity and specificity of diagnoses made by both GPs and ECG recorders,
  • Kappa: interobserver agreement on the diagnoses made by two cardiologists.
results
Results
  • 902 of 905 ECGs
  • 429 men (47.6%), 473 women (52.4%)
  • Median age: 41 years (men and women)
  • Kappa = 0.856 (95% CI: 0.742-0.970)
results abnormal ecg1
Results abnormal ECG
  • If the sensitivity = 69.8%
results any bundle branch
Results any bundle branch
  • Sensitivity and specificity: no significant difference
conclusions
Conclusions
  • Higher sensitivity with ECG recorder than with GPs  false-negative low for recoder

 stay very low in general

 the GP have to attempt to achieve a better sensitivity (abnormal ECG reading by the recorder to a specialist, a training,…)

  • Higher specificity with GPs than with ECG recorder
conclusions1
Conclusions
  • PPV: low
  • PNV: high
  • Low prevalence of abnormal ECG in this population
positive point
Positive point
  • GPs never knew that their ECG interpretation skills will be evaluated  real skills of the GPs
negative points
Negative points
  • Not blinding of the GPs
  • Not blinding of the cardiologist
  • The same training in Belgium and in Denmark?
  • One ECG recorder; and the other ones?
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