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Emergency Physician Interpretation of Prehospital, Paramedic-Acquired Electrocardiograms

Published online by Cambridge University Press:  28 June 2012

Jeffrey A. Schaffer ,
Terence D. Valenzuela ,
Arthur L. Wright ,
Lani Clark ,
Riemke M. Brakema ,
Steven Goldman  and
Daniel W. Spaite
Jeffrey A. Schaffer
Affiliation:
The Arizona Emergency Medicine Research Center, Tucson, Ariz.
Terence D. Valenzuela*
Affiliation:
The Arizona Emergency Medicine Research Center, Tucson, Ariz.
Arthur L. Wright
Affiliation:
University of Arizona College of Medicine, Department of Mathematics, University of Arizona, Tucson, Ariz.
Lani Clark
Affiliation:
The Arizona Emergency Medicine Research Center, Tucson, Ariz.
Riemke M. Brakema
Affiliation:
The Arizona Emergency Medicine Research Center, Tucson, Ariz.
Steven Goldman
Affiliation:
Section of Cardiology, Department of Internal Medicine, Veterans Administration Medical Center, Tucson, Ariz.
Daniel W. Spaite
Affiliation:
The Arizona Emergency Medicine Research Center, Tucson, Ariz.
*
Emergency Medicine, Arizona Health Sciences Center, 1501 N. Campbell Avenue, Tucson, AZ 85724USA
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Abstract

Hypothesis:

Emergency physician interpretation of prehospital, paramedic-acquired, electrocardiograms (ECG) is accurate judged by comparison with that of a reference cardiologist.

Methods:

Twelve-lead ECGs were obtained by paramedics in the field from 150 patients with acute chest pain. The ECGs were transmitted by cellular telephone to a central location. Each ECG was assessed for evidence of acute myocardial infarction (AMI) by: 1) a third-year, emergency medicine resident (EMP-R); 2) a residency-trained, board-certified, emergency physician (EMP-RT); 3) an emergency physician board certified under the practice option (EMP-PT); and 4) a board-certified cardiologist. Agreement between each emergency physician and the cardiologist was assessed by the kappa statistic. Hospital records were reviewed for final diagnosis of each patient.

Results:

Sixteen of 150 (10.7%) patients received a hospital discharge diagnosis of AMI. Sensitivity of physician interpretation ranged from 0.31 to 0.56. All physicians achieved specificity of 0.99. False-positive rates for the physicians ranged from 0.18–0.29. The mean positive predictive value for the four physicians was 0.77±0.05; the mean negative predictive value was 0.94±0.01. The total agreements between the EMP-R, EMP-RT, and EMP-PT and the cardiologists were 0.97, 0.96, and 0.97, respectively. Kappa values for agreement between the emergency physicians and the cardiologist ranged from 0.65–0.79.

Conclusions:

Residency-trained or board-certified emergency physician interpretations of prehospital, paramedic-acquired 12-lead ECGs show a high degree of agreement with reference cardiologist interpretations.

Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 7 , Issue 3 , September 1992 , pp. 251 - 255
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1992

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