• E J Westdrop, M C Gratton, and W A Watson.
• Department of Emergency Medicine, University of Missouri-Kansas City.
• Ann Emerg Med. 1992 May 1;21(5):541-4.

Study ObjectiveTo determine the concordance of emergency physicians' and cardiologists' interpretations of abnormal ECGs.DesignRetrospective cohort study.SettingAn urban teaching hospital emergency department.Type Of ParticipantsPatients with an abnormal ED ECG that was interpreted by both an emergency physician and a cardiologist and who were discharged from the ED.Measurements And Main ResultsSeven hundred sixteen ECGs were reviewed; 143 abnormal ECGs were obtained on patients discharged from the ED. The cardiologist's final interpretation was defined as correct, and discordance was any abnormality not identified by the emergency physician. The overall discordance between emergency physicians' and cardiologists' ECG interpretations was 58.0% (P less than .001). Twenty-five discordant interpretations were likely clinically significant--representing missed ischemia, infarct, and abnormal rhythm. There was no ED interpretation in three of these. The most frequently missed findings by emergency physicians were evidence of ischemia/infarct of the anterior wall and atrial fibrillation. Twenty-one of the 83 patients with discordant interpretations were lost to follow-up. Two cases had a clinically significant discrepancy that would have altered patient care.ConclusionAlthough the overall discordance was more than 50%, most ED misinterpretations were determined unlikely to have clinical significance. Additional studies are needed to identify variables that contribute to ED ECG misinterpretation and to develop methods to resolve these difficulties.

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