Abstract:
BACKGROUND:The impact of misinterpretation of the ECG in patients with acute myocardial infarction (AMI) in the emergency department (ED) setting is not well known. Our goal was to assess the prevalence of the failure to identify high-risk ECG findings in ED patients with AMI and to determine whether this failure is associated with lower-quality care. METHODS AND RESULTS:In a retrospective cohort study of consecutive patients presenting to 5 EDs in California and Colorado from July 1, 2000, through June 30, 2002, with confirmed AMI (n=1684), we determined the frequency of the failure by the treating provider to identify significant ST-segment depressions, ST-segment elevations, or T-wave inversions on the presenting ECG. In multivariable models, we assessed the relationship between missed high-risk ECG findings and evidence-based therapy in the ED after adjustment for patient characteristics and site of care. High-risk ECG findings were not documented in 201 patients (12%). The failure to identify high-risk findings was independently associated with a higher odds of not receiving treatment among ideal candidates for aspirin (odds ratio [OR], 2.13; 95% confidence interval [CI], 1.51 to 2.94), beta-blockers (OR, 1.85; 95% CI, 1.14 to 3.03), and reperfusion therapy (OR, 7.69; 95% CI, 3.57 to 16.67). Among patients with missed high-risk ECG findings, in-hospital mortality was 7.9% compared with 4.9% among those without missed findings (P=0.1). CONCLUSIONS:The failure to identify high-risk ECG findings in patients with AMI results in lower-quality care in the ED. Systematic processes to improve ECG interpretation may have important implications for patient treatment and outcomes.
journal_name
Circulationjournal_title
Circulationauthors
Masoudi FA,Magid DJ,Vinson DR,Tricomi AJ,Lyons EE,Crounse L,Ho PM,Peterson PN,Rumsfeld JS,Emergency Department Quality in Myocardial Infarction Study Investigators.doi
10.1161/CIRCULATIONAHA.106.623652subject
Has Abstractpub_date
2006-10-10 00:00:00pages
1565-71issue
15eissn
0009-7322issn
1524-4539pii
CIRCULATIONAHA.106.623652journal_volume
114pub_type
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