Document Detail

The diagnosis of myocardial infarction in critically ill patients: an agreement study.
MedLine Citation:
PMID:  19327310     Owner:  NLM     Status:  MEDLINE    
PURPOSE: The aim of the study was to assess agreement among 4 intensivists in diagnosing myocardial infarction (MI) in critically ill patients based on screening electrocardiograms (ECGs) and cardiac troponin (cTn) levels. METHODS: Consecutive patients admitted to a medical-surgical intensive care unit (ICU) underwent systematic screening with 12-lead ECGs and cTn measurements throughout their ICU stay. Independently, 4 raters interpreted the ECGs assessing for changes indicative of ischemia and then classified each patient as to whether they met diagnostic criteria for MI based on the screening cTn measurements and ECG results. A priori, 2 raters were designated the primary adjudicators, and their consensus was used as the reference for the agreement statistics. Agreement on MI diagnosis was calculated for the 4 raters and expressed as raw agreement, kappa (chance-corrected agreement) and varphi (chance-independent agreement, calculated using pairs). RESULTS: Among 103 enrolled patients, 37 (35.9%) had MI according to the primary adjudicators. The raw agreement for diagnosing MI was 79% (substantial), kappa was 0.24 (fair), and varphi ranged from 0.12 to 0.73 (slight to substantial). CONCLUSIONS: Diagnosing MI in the ICU remains a challenge due to variable agreement in 12-lead ECG interpretation. Such variation in practice may contribute to underrecognition of MI during critical illness.
Wendy Lim; Andrea Tkaczyk; Paula Holinski; Ismael Qushmaq; Michael Jacka; Vikas Khera; P J Devereaux; Irene Terrenato; Holger Schunemann; Diane Heels-Ansdell; Mark Crowther; Deborah Cook
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2009-01-17
Journal Detail:
Title:  Journal of critical care     Volume:  24     ISSN:  1557-8615     ISO Abbreviation:  J Crit Care     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-08-11     Completed Date:  2009-12-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8610642     Medline TA:  J Crit Care     Country:  United States    
Other Details:
Languages:  eng     Pagination:  447-52     Citation Subset:  IM    
Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
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MeSH Terms
Aged, 80 and over
Critical Illness*
Intensive Care Units
Middle Aged
Myocardial Infarction / diagnosis*
Troponin T / blood*
Reg. No./Substance:
0/Troponin T

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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