Interpretation of the emergency electrocardiogram by junior hospital doctors

Abstract

Objective: To assess the ability of a cohort of junior hospital doctors to interpret ECGs which have immediate clinical relevance and influence subsequent management of patients.

Methods: 57 junior hospital doctors were interviewed and asked to complete a standard questionnaire which included eight ECGs for interpretation and a supplementary question relating to the administration of thrombolytic treatment. Each doctor was assessed over a 48 h period while they performed their daily clinical duties.

Results: The major abnormality of anterior myocardial infarction was recognised by almost all doctors. There was difficulty in the interpretation of posterior myocardial infarction and second degree heart block. Most myocardial infarctions would have been given satisfactory thrombolysis, but there was a reluctance to use this treatment in patients with posterior myocardial infarction and left bundle brach block. A few patients without myocardial infarction would have received thrombolytic treatment.

Conclusions: There is varying ability among junior hospital doctors in the interpretation of the emergency electrocardiogram. The results are of concern as poor interpretation of the ECG can result in inappropriate management. As a result of the findings of this study it is proposed to introduce more formal training in the interpretation of clinically relevant ECG abnormalities for junior hospital doctors.