Podcast 806: Normal ECGs

Contributor: Jared Scott, MD

Educational Pearls:

• Physicians are typically advised not to trust computer interpretation of ECGs
• Retrospective study was done of computer interpreted normal ECGs to evaluate the accuracy of such an interpretation
• 989 ECGs were interpreted as "Normal sinus rhythm, Normal ECG" by proprietary cardiology software on MUSE Cardiology Information System
• These EKGs received follow up interpretation by cardiologists which was considered the "gold standard" for interpretation
• 18.6% of "normal ECG" had at least one abnormality identified by the cardiologist
• 6.1% of these discrepant interpretations were deemed potentially clinically significant
• Only 1% were classified as possible ischemia
• On retrospective chart review:
• Six patients underwent non-emergent cardiac catheterization
• Two had cardiac interventions
• One had three PCI stents to a prior CABG graft
• One had a scheduled outpatient cardiac catheterization but was admitted and ended up receiving a CABG graft
• Study showed that discrepancies between computer interpretation of "Normal ECG" and cardiologist re-interpretation were not clinically significant
• Emergency physicians should still screen ECGs per AHA guidelines

References

Winters LJ, Dhillon RK, Pannu GK, Terrassa P, Holmes JF, Bing ML. Emergent cardiac outcomes in patients with normal electrocardiograms in the emergency department. Am J Emerg Med. 2022;51:384-387.

Summarized by Mark O'Brien, MS4 | Edited by John Spartz MD & Erik Verzemnieks, MD

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