Physician electrocardiogram reading in the emergency department--accuracy and effect on triage decisions: findings from a multicenter study.

Abstract

OBJECTIVE: To determine how well physicians in emergency departments read electrocardiographic (ECG) ST-segment and T-wave changes and how this affects triage decisions. METHODS: In the emergency departments of six teaching and nonteaching hospitals, the authors prospectively collected physicians' ECG readings and clinical data for 2,320 patients presenting with possible acute cardiac ischemia from 1979 to 1981. RESULTS: Compared with electrocardiographers, the study physicians misread as normal 41% of abnormal ST segments and 36% of abnormal T waves, and misread as abnormal 14% of normal ST segments and 17% of normal T waves. Trainees were significantly more sensitive readers of T-wave changes but less specific readers of both ST-segment and T-wave changes when compared with other physicians. Suboptimal triage was more likely when abnormal ST segments or T waves were misread as normal (22% vs. 11%, p less than 0.001, and 18% vs. 14%, p = 0.08, respectively). Conversely, coronary care unit (CCU) admission for patients without acute cardiac ischemia was more likely when normal ST segments were misread as abnormal (23% vs. 13%, p less than 0.0001). CONCLUSIONS: Physicians in emergency departments often misread the ST segments and T waves of patients with possible acute cardiac ischemia. Misreading is related to suboptimal triage and unnecessary CCU admission. Training emergency physicians to make these distinctions more accurately could improve medical care and hospital utilization.