| Failure to agree on the electrocardiographic diagnosis of ventricular tachycardia. | |
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MedLine Citation:
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PMID: 8572445 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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STUDY OBJECTIVE: To determine the extent of interobserver agreement in the ECG diagnosis of ventricular tachycardia (VT) by using a four-step algorithm and three observers. METHODS: Simulated emergency department setting from records of an urban university teaching hospital. All ECGs taken in the ED during a 2-year period that showed a QRS duration of more than 120 msec and a heart rate faster than 110 beats per minute were reviewed. ECGs were categorized as demonstrating sinus rhythm (SR), irregular broad-complex tachycardia (I-BCT), or regular broad-complex tachycardia (BCT). Copies of the BCT ECGs and short clinical histories were given to each of three emergency physicians, who used a published, four-step algorithm (the Brugada algorithm) to categorize the BCT ECGs as indicating VT, indicating supraventricular tachycardia with aberrancy (SVT-A), or indeterminate. Interobserver agreement was assessed with the K-statistic. RESULTS: The records contained 178 ECGs, 88 of which were SR, 63 I-BCT, and 27 BCT. The 27 BCT ECGs were selected for review. The emergency physicians disagreed with each other 22% of the time in differentiating VT from SVT-A (K = .58). CONCLUSION: Application of the algorithm to actual clinical practice in the ED would probably result in the misdiagnosis of a substantial minority of patients having BCT, with potentially serious adverse consequences. |
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Authors:
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M E Herbert; S R Votey; M T Morgan; P Cameron; L Dziukas |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Annals of emergency medicine Volume: 27 ISSN: 0196-0644 ISO Abbreviation: Ann Emerg Med Publication Date: 1996 Jan |
Date Detail:
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Created Date: 1996-03-04 Completed Date: 1996-03-04 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8002646 Medline TA: Ann Emerg Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 35-8 Citation Subset: AIM; IM |
Affiliation:
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Olive View-UCLA Emergency Department, Olive View Medical Center, Sylmar, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Algorithms* Diagnosis, Differential Diagnostic Errors Electrocardiography / standards* Emergency Service, Hospital Female Humans Male Middle Aged Observer Variation Reproducibility of Results Sensitivity and Specificity Tachycardia, Supraventricular / classification, diagnosis* Tachycardia, Ventricular / classification, diagnosis* |
| Comments/Corrections | |
Comment In:
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Ann Emerg Med. 1996 Aug;28(2):244
[PMID:
8759598
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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