Diagnostic Reasoning for ST-Segment Elevation Myocardial Infarction (STEMI) Interpretation Is Preserved Despite Fatigue
| Autor: | Adam R. Kellogg, Gregory Garra, Ryan A. Coute |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Circadian disruption
Cardiac Catheterization medicine.medical_specialty medicine.medical_treatment Cardiology Myocardial Infarction Diagnostic reasoning Affect (psychology) Diagnosis Differential Electrocardiography Primary outcome Surveys and Questionnaires Numeric Rating Scale Humans Medicine ST segment Prospective Studies Myocardial infarction Fatigue Original Research Cardiac catheterization business.industry Internship and Residency General Medicine medicine.disease Circadian Rhythm Emergency Medicine Physical therapy Clinical Competence business |
| Zdroj: | Journal of Graduate Medical Education. 7:27-31 |
| ISSN: | 1949-8357 1949-8349 |
| Popis: | Background Fatigue and sleepiness contribute to medical errors, although the effect of circadian disruption and fatigue on diagnostic reasoning skills is largely unknown. Objective To determine whether circadian disruption and fatigue negatively affect the emergency medicine (EM) resident's ability to make important clinical decisions based on electrocardiogram (ECG) interpretation. Methods Senior EM residents at 2 programs completed a questionnaire consisting of various measures of fatigue followed by an ECG test packet of ST-segment elevation myocardial infarction (STEMI) and STEMI mimics. Participants were asked to examine each ECG and determine whether cardiac catheterization laboratory activation (CLA) was indicated, and to report their confidence in their decision making on an 11-point, numeric rating scale. The primary outcome measured was a pairwise difference in accuracy of CLA between daytime and overnight testing. Results A total of 23 residents were enrolled in 2011 and 2012. Subjects demonstrated significant differences in multiple measures of sleepiness and fatigue during overnight periods. The median (interquartile range [IQR]) accuracy of CLA was not significantly different between daytime and overnight (70% [IQR, 50–80] versus 70% [IQR, 60–70], P = .82). There were no significant differences in the median number of overcalls (CLA when not a STEMI) and undercalls (no CLA when a STEMI was present; P = .57 and .37, respectively). Diagnostic confidence and confidence in CLA were not statistically different between daytime and overnight. Conclusions Despite a measurable degree of fatigue, senior EM residents experienced no decrease in their ability to accurately make CLA decisions based on ECG interpretation. |
| Databáze: | OpenAIRE |
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