Document Detail

Failure to agree on the electrocardiographic diagnosis of ventricular tachycardia.
MedLine Citation:
PMID:  8572445     Owner:  NLM     Status:  MEDLINE    
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.
M E Herbert; S R Votey; M T Morgan; P Cameron; L Dziukas
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of emergency medicine     Volume:  27     ISSN:  0196-0644     ISO Abbreviation:  Ann Emerg Med     Publication Date:  1996 Jan 
Date Detail:
Created Date:  1996-03-04     Completed Date:  1996-03-04     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8002646     Medline TA:  Ann Emerg Med     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  35-8     Citation Subset:  AIM; IM    
Olive View-UCLA Emergency Department, Olive View Medical Center, Sylmar, USA.
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MeSH Terms
Diagnosis, Differential
Diagnostic Errors
Electrocardiography / standards*
Emergency Service, Hospital
Middle Aged
Observer Variation
Reproducibility of Results
Sensitivity and Specificity
Tachycardia, Supraventricular / classification,  diagnosis*
Tachycardia, Ventricular / classification,  diagnosis*
Comment In:
Ann Emerg Med. 1996 Aug;28(2):244   [PMID:  8759598 ]

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