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How Accurate Is Your ECG Interpretation?

November 13, 2020

Written by Clay Smith

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We all have room for improvement in ECG interpretation. Training improves accuracy.

Why does this matter?
ECG interpretation is a core skill for emergency physicians. But how good are we at it?

Is wrong half the time so bad?
This was a systematic review of 78 studies to determine the accuracy of physician ECG interpretation. Pooled median accuracy at all levels of experience, including studies with medical students and residents, was 54% pre-training and 67% post-training. Even among practicing physicians, pre-training accuracy was only 69% (up to 81% with training) and rose to 75% (up to 88% with training) among cardiologists. There was significant heterogeneity among studies in how ECG skills were assessed, and physician accuracy varied widely among studies. There are several problems with the current state of ECG education assessment. Most tests are made up ad hoc. There is not a reference standard set of ECG tracings. Next, ECG tests tend to be short (most ~10 questions), which limits precision. Also, the gold standard for the “correct” answer was usually based on expert consensus. Finally, the validity of the evidence for the tracings was frequently in question (i.e. was it confirmed pericarditis?). All that said, the prevailing message is that we are not as good as we think we are, but training improves performance. Like so many things, we always have room to learn, grow, and improve.

Accuracy of Physicians’ Electrocardiogram Interpretations: A Systematic Review and Meta-analysis. JAMA Intern Med. 2020 Sep 28;e203989. doi: 10.1001/jamainternmed.2020.3989. Online ahead of print.

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