Missed myocardial ischaemia in the accident and emergency department: E.C.G. a need for audit?

Abstract

Accident and Emergency Department Senior House Officers rely heavily on their ECG interpretation skills in the diagnosis and management of patients with chest pain. This prospective double-blind study was designed to test the accuracy with which Accident and Emergency Senior House Officers interpret ECGs, by comparing their interpretation with that of a Consultant Cardiologist. ECGs from 279 of 314 consecutive patients with chest pain were analysed. Ninety per cent of normal electrocardiographs and 57% of abnormal ECGs were correctly interpreted. Despite the inaccurate interpretation of 43% of abnormal ECGs, 96.5% of the patients in the study were considered to have been managed correctly. Audit of all ECGs recorded in the Accident and Emergency Department should be undertaken by someone with experience of ECG interpretation. New A and E staff should receive training in the interpretation of ECGs.