Cargando…

Human–Computer Agreement of Electrocardiogram Interpretation for Patients Referred to and Declined for Primary Percutaneous Coronary Intervention: Retrospective Data Analysis Study

BACKGROUND: When a patient is suspected of having an acute myocardial infarction, they are accepted or declined for primary percutaneous coronary intervention partly based on clinical assessment of their 12-lead electrocardiogram (ECG) and ST-elevation myocardial infarction criteria. OBJECTIVE: We r...

Descripción completa

Detalles Bibliográficos
Autores principales: Iftikhar, Aleeha, Bond, Raymond, Mcgilligan, Victoria, Leslie, Stephen J, Knoery, Charles, Shand, James, Ramsewak, Adesh, Sharma, Divyesh, McShane, Anne, Rjoob, Khaled, Peace, Aaron
Formato: Online Artículo Texto
Lenguaje:English
Publicado: JMIR Publications 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967222/
https://www.ncbi.nlm.nih.gov/pubmed/33650984
http://dx.doi.org/10.2196/24188
_version_ 1783665829497274368
author Iftikhar, Aleeha
Bond, Raymond
Mcgilligan, Victoria
Leslie, Stephen J
Knoery, Charles
Shand, James
Ramsewak, Adesh
Sharma, Divyesh
McShane, Anne
Rjoob, Khaled
Peace, Aaron
author_facet Iftikhar, Aleeha
Bond, Raymond
Mcgilligan, Victoria
Leslie, Stephen J
Knoery, Charles
Shand, James
Ramsewak, Adesh
Sharma, Divyesh
McShane, Anne
Rjoob, Khaled
Peace, Aaron
author_sort Iftikhar, Aleeha
collection PubMed
description BACKGROUND: When a patient is suspected of having an acute myocardial infarction, they are accepted or declined for primary percutaneous coronary intervention partly based on clinical assessment of their 12-lead electrocardiogram (ECG) and ST-elevation myocardial infarction criteria. OBJECTIVE: We retrospectively determined the agreement rate between human (specialists called activator nurses) and computer interpretations of ECGs of patients who were declined for primary percutaneous coronary intervention. METHODS: Various features of patients who were referred for primary percutaneous coronary intervention were analyzed. Both the human and computer ECG interpretations were simplified to either “suggesting” or “not suggesting” acute myocardial infarction to avoid analysis of complex heterogeneous and synonymous diagnostic terms. Analyses, to measure agreement, and logistic regression, to determine if these ECG interpretations (and other variables such as patient age, chest pain) could predict patient mortality, were carried out. RESULTS: Of a total of 1464 patients referred to and declined for primary percutaneous coronary intervention, 722 (49.3%) computer diagnoses suggested acute myocardial infarction, whereas 634 (43.3%) of the human interpretations suggested acute myocardial infarction (P<.001). The human and computer agreed that there was a possible acute myocardial infarction for 342 out of 1464 (23.3%) patients. However, there was a higher rate of human–computer agreement for patients not having acute myocardial infarctions (450/1464, 30.7%). The overall agreement rate was 54.1% (792/1464). Cohen κ showed poor agreement (κ=0.08, P=.001). Only the age (odds ratio [OR] 1.07, 95% CI 1.05-1.09) and chest pain (OR 0.59, 95% CI 0.39-0.89) independent variables were statistically significant (P=.008) in predicting mortality after 30 days and 1 year. The odds for mortality within 1 year of referral were lower in patients with chest pain compared to those patients without chest pain. A referral being out of hours was a trending variable (OR 1.41, 95% CI 0.95-2.11, P=.09) for predicting the odds of 1-year mortality. CONCLUSIONS: Mortality in patients who were declined for primary percutaneous coronary intervention was higher than the reported mortality for ST-elevation myocardial infarction patients at 1 year. Agreement between computerized and human ECG interpretation is poor, perhaps leading to a high rate of inappropriate referrals. Work is needed to improve computer and human decision making when reading ECGs to ensure that patients are referred to the correct treatment facility for time-critical therapy.
format Online
Article
Text
id pubmed-7967222
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher JMIR Publications
record_format MEDLINE/PubMed
spelling pubmed-79672222021-03-24 Human–Computer Agreement of Electrocardiogram Interpretation for Patients Referred to and Declined for Primary Percutaneous Coronary Intervention: Retrospective Data Analysis Study Iftikhar, Aleeha Bond, Raymond Mcgilligan, Victoria Leslie, Stephen J Knoery, Charles Shand, James Ramsewak, Adesh Sharma, Divyesh McShane, Anne Rjoob, Khaled Peace, Aaron JMIR Med Inform Original Paper BACKGROUND: When a patient is suspected of having an acute myocardial infarction, they are accepted or declined for primary percutaneous coronary intervention partly based on clinical assessment of their 12-lead electrocardiogram (ECG) and ST-elevation myocardial infarction criteria. OBJECTIVE: We retrospectively determined the agreement rate between human (specialists called activator nurses) and computer interpretations of ECGs of patients who were declined for primary percutaneous coronary intervention. METHODS: Various features of patients who were referred for primary percutaneous coronary intervention were analyzed. Both the human and computer ECG interpretations were simplified to either “suggesting” or “not suggesting” acute myocardial infarction to avoid analysis of complex heterogeneous and synonymous diagnostic terms. Analyses, to measure agreement, and logistic regression, to determine if these ECG interpretations (and other variables such as patient age, chest pain) could predict patient mortality, were carried out. RESULTS: Of a total of 1464 patients referred to and declined for primary percutaneous coronary intervention, 722 (49.3%) computer diagnoses suggested acute myocardial infarction, whereas 634 (43.3%) of the human interpretations suggested acute myocardial infarction (P<.001). The human and computer agreed that there was a possible acute myocardial infarction for 342 out of 1464 (23.3%) patients. However, there was a higher rate of human–computer agreement for patients not having acute myocardial infarctions (450/1464, 30.7%). The overall agreement rate was 54.1% (792/1464). Cohen κ showed poor agreement (κ=0.08, P=.001). Only the age (odds ratio [OR] 1.07, 95% CI 1.05-1.09) and chest pain (OR 0.59, 95% CI 0.39-0.89) independent variables were statistically significant (P=.008) in predicting mortality after 30 days and 1 year. The odds for mortality within 1 year of referral were lower in patients with chest pain compared to those patients without chest pain. A referral being out of hours was a trending variable (OR 1.41, 95% CI 0.95-2.11, P=.09) for predicting the odds of 1-year mortality. CONCLUSIONS: Mortality in patients who were declined for primary percutaneous coronary intervention was higher than the reported mortality for ST-elevation myocardial infarction patients at 1 year. Agreement between computerized and human ECG interpretation is poor, perhaps leading to a high rate of inappropriate referrals. Work is needed to improve computer and human decision making when reading ECGs to ensure that patients are referred to the correct treatment facility for time-critical therapy. JMIR Publications 2021-03-02 /pmc/articles/PMC7967222/ /pubmed/33650984 http://dx.doi.org/10.2196/24188 Text en ©Aleeha Iftikhar, Raymond Bond, Victoria Mcgilligan, Stephen J Leslie, Charles Knoery, James Shand, Adesh Ramsewak, Divyesh Sharma, Anne McShane, Khaled Rjoob, Aaron Peace. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 02.03.2021. https://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Informatics, is properly cited. The complete bibliographic information, a link to the original publication on http://medinform.jmir.org/, as well as this copyright and license information must be included.
spellingShingle Original Paper
Iftikhar, Aleeha
Bond, Raymond
Mcgilligan, Victoria
Leslie, Stephen J
Knoery, Charles
Shand, James
Ramsewak, Adesh
Sharma, Divyesh
McShane, Anne
Rjoob, Khaled
Peace, Aaron
Human–Computer Agreement of Electrocardiogram Interpretation for Patients Referred to and Declined for Primary Percutaneous Coronary Intervention: Retrospective Data Analysis Study
title Human–Computer Agreement of Electrocardiogram Interpretation for Patients Referred to and Declined for Primary Percutaneous Coronary Intervention: Retrospective Data Analysis Study
title_full Human–Computer Agreement of Electrocardiogram Interpretation for Patients Referred to and Declined for Primary Percutaneous Coronary Intervention: Retrospective Data Analysis Study
title_fullStr Human–Computer Agreement of Electrocardiogram Interpretation for Patients Referred to and Declined for Primary Percutaneous Coronary Intervention: Retrospective Data Analysis Study
title_full_unstemmed Human–Computer Agreement of Electrocardiogram Interpretation for Patients Referred to and Declined for Primary Percutaneous Coronary Intervention: Retrospective Data Analysis Study
title_short Human–Computer Agreement of Electrocardiogram Interpretation for Patients Referred to and Declined for Primary Percutaneous Coronary Intervention: Retrospective Data Analysis Study
title_sort human–computer agreement of electrocardiogram interpretation for patients referred to and declined for primary percutaneous coronary intervention: retrospective data analysis study
topic Original Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967222/
https://www.ncbi.nlm.nih.gov/pubmed/33650984
http://dx.doi.org/10.2196/24188
work_keys_str_mv AT iftikharaleeha humancomputeragreementofelectrocardiograminterpretationforpatientsreferredtoanddeclinedforprimarypercutaneouscoronaryinterventionretrospectivedataanalysisstudy
AT bondraymond humancomputeragreementofelectrocardiograminterpretationforpatientsreferredtoanddeclinedforprimarypercutaneouscoronaryinterventionretrospectivedataanalysisstudy
AT mcgilliganvictoria humancomputeragreementofelectrocardiograminterpretationforpatientsreferredtoanddeclinedforprimarypercutaneouscoronaryinterventionretrospectivedataanalysisstudy
AT lesliestephenj humancomputeragreementofelectrocardiograminterpretationforpatientsreferredtoanddeclinedforprimarypercutaneouscoronaryinterventionretrospectivedataanalysisstudy
AT knoerycharles humancomputeragreementofelectrocardiograminterpretationforpatientsreferredtoanddeclinedforprimarypercutaneouscoronaryinterventionretrospectivedataanalysisstudy
AT shandjames humancomputeragreementofelectrocardiograminterpretationforpatientsreferredtoanddeclinedforprimarypercutaneouscoronaryinterventionretrospectivedataanalysisstudy
AT ramsewakadesh humancomputeragreementofelectrocardiograminterpretationforpatientsreferredtoanddeclinedforprimarypercutaneouscoronaryinterventionretrospectivedataanalysisstudy
AT sharmadivyesh humancomputeragreementofelectrocardiograminterpretationforpatientsreferredtoanddeclinedforprimarypercutaneouscoronaryinterventionretrospectivedataanalysisstudy
AT mcshaneanne humancomputeragreementofelectrocardiograminterpretationforpatientsreferredtoanddeclinedforprimarypercutaneouscoronaryinterventionretrospectivedataanalysisstudy
AT rjoobkhaled humancomputeragreementofelectrocardiograminterpretationforpatientsreferredtoanddeclinedforprimarypercutaneouscoronaryinterventionretrospectivedataanalysisstudy
AT peaceaaron humancomputeragreementofelectrocardiograminterpretationforpatientsreferredtoanddeclinedforprimarypercutaneouscoronaryinterventionretrospectivedataanalysisstudy