Can an ECG performed during emergency department triage and interpreted as normal by computer analysis safely wait for clinician review until the time of patient assessment? A pilot study

Autor: Andrew Tabner, Graham Johnson, Apostolos Fakis, Michael Jones
Rok vydání: 2021
Předmět:
Zdroj: Journal of Electrocardiology. 68:145-149
ISSN: 0022-0736
DOI: 10.1016/j.jelectrocard.2021.08.006
Popis: Introduction Electrocardiograms (ECGs) are frequently performed during patient triage in Emergency Departments (EDs). Emergency Physicians (EPs) are interrupted during other tasks to review ECGs. Critics believe this practice could lead to distraction with consequent medical error and decision fatigue. ECGs can be interpreted by computer software at the time of capture; some evidence exists to suggest that an ECG performed during ED triage with an immediate computer interpretation (ICI) of ‘normal’ will seldom contain information necessitating a change to triage management. Material and methods All ED triage ECGs performed in the Royal Derby Hospital between 13th July 2017 and 12th July 2018 in patients without chest pain and with an ICI of ‘normal’ were identified through a database search. Forty were randomly selected and reviewed by two EPs (blinded to patient details, ICI and outcome) who were asked to identify those that required a change to triage management. Results The study processes were feasible. At least one of the two EP reviewers felt that a change to triage management was required in 48% of cases (e.g. “review patient”, “obtain blood gas”, “review old ECGs”); they agreed on the need for change of management in 13% of cases. An ICI of normal had a NPV of 53% (95% CI 37–67%) for the need for a change to triage management based upon ECG findings. Inter-observer agreement was poor (kappa = 0.17). Conclusions Based on these results, ED triage ECGs should still be presented to EPs for immediate review regardless of the ICI. Inter-observer agreement between EPs was poor. Further research is required to link triage ECG interpretation, need for intervention and patient outcome.
Databáze: OpenAIRE
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