Is computer interpretation of “Normal ECG” reliable?

Year 2018, , 80 - 85, 01.08.2018

Özge Turgay Yıldırım , Mustafa Emin Çanakçı

https://doi.org/10.23884/ijhsrp.2018.3.2.05

Abstract

Background

Electrocardiographs (ECG) taken on an emergency clinic
should be evaluated by emergency physician within 10 minutes. However, since
the number of emergency physicians is not sufficient, physicians have to look
at these ECGs during other patient examinations, which causes interruptions.
Today, most ECG devices have computer-based analysis systems. Our aim is to
determine how reliable the computer interpretations are to determine if
patients with “Normal ECG” also need immediate attention.

Methods

All triage ECGs from patients applied to Emergency
Clinic between 01.03.2018 and 31.03.2018 were evaluated. Patients under age of
18 were excluded. The ECGs computer interpreted as normal were evaluated by a
cardiologist and if the ECGs found to be abnormal, these ECGs were than
analyzed by an emergency specialist. Then these patients’ diagnosis, follow up
and treatment were obtained from the hospital records.

Results

A total of 1225 ECGs were evaluated. 27.8% (n=341)
were interpreted as “normal ECG” by the computer. From the ECGs which the
computer interpreted as normal, 18 (5.3%) of them were assessed by cardiologist
as “not normal”. These 18 ECGs were also assessed by emergency resident as
abnormal. According to these results negative predictive value of the computer
is 94.7% and sensitivity of the test was 98.0%.

Conclusions

We investigated the reliability of "normal
ECG" evaluation of ECG devices in this study. Our study suggests that the
devices’ “normal ECG” assessment was reliable. This study should be repeated
with a larger study group on a longer period of time.

Keywords

Electrocardiography, Computer interpretation

References

• 1. Guilbert JJ. The world health report 2002 – reducing risks, promoting healthy life. Educ Health (Abingdon) 2003;16:230.
• 2. Institute of Medicine (US) Committee on Preventing the Global Epidemic of Cardiovascular Disease: Meeting the Challenges in Developing Countries. 2010 Epidemiology of cardiovascular disease. In Promoting cardiovascular health in the developing world: a critical challenge to achieve global health (eds V Fuster, BB Kelly). Washington, DC: National Academies Press. See https://www.ncbi.nlm.nih.gov/books/NBK45688/
• 3. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). Circulation 2004; 110:588-636.
• 4. Pipberger HV, Dunn RA, Berson AS. Computer Methods in Electrocardiography. Annu Rev Biophys Bioeng. 1975; 4:15-42.
• 5. Lyon A, Minchole A, Martinez JP, et al. Computational techniques for ECG analysis and interpretation in light of their contribution to medical advances. J R Soc Interface. 2018 Jan;15(138). pii: 20170821.
• 6. Hughes KE, Lewis SM, Katz L. Safety of Computer Interpretation of Normal Triage ECGs. Acad Emerg Med. 2017 Jan;24(1):120-124.
• 7. Snyder CS, Fenrich AL, Friedman RA. The emergency department versus the computer: which is the better electrocardiographer? Pediatr Cardiol 2003; 24:364–368.
• 8. Clark EN, Sejersten M, Clemmensen P. Automated Electrocardiogram Interpretation Programs Versus Cardiologists’ Triage Decision Making Based on Teletransmitted Data in Patients With Suspected Acute Coronary Syndrome. Am J Cardiol. 2010; 106(12):1696-1702.