Introduction

Electrocardiograms (ECGs) are frequently performed during patient triage in Emergency Departments (EDs). Emergency Physicians (EPs) are interrupted during other tasks to review ECGs. Critics believe this practice could lead to distraction with consequent medical error and decision fatigue.

ECGs can be interpreted by computer software at the time of capture; some evidence exists to suggest that an ECG performed during ED triage with an immediate computer interpretation (ICI) of ‘normal’ will seldom contain information necessitating a change to triage management.

Material and methods

All ED triage ECGs performed in the Royal Derby Hospital between 13th July 2017 and 12th July 2018 in patients without chest pain and with an ICI of ‘normal’ were identified through a database search. Forty were randomly selected and reviewed by two EPs (blinded to patient details, ICI and outcome) who were asked to identify those that required a change to triage management.

Results

The study processes were feasible. At least one of the two EP reviewers felt that a change to triage management was required in 48% of cases (e.g. “review patient”, “obtain blood gas”, “review old ECGs”); they agreed on the need for change of management in 13% of cases. An ICI of normal had a NPV of 53% (95% CI 37–67%) for the need for a change to triage management based upon ECG findings. Inter-observer agreement was poor (kappa = 0.17).

Conclusions

Based on these results, ED triage ECGs should still be presented to EPs for immediate review regardless of the ICI. Inter-observer agreement between EPs was poor. Further research is required to link triage ECG interpretation, need for intervention and patient outcome.

中文翻译：

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在急诊科分诊期间执行并通过计算机分析解释为正常的 ECG 是否可以安全地等待临床医生审查，直到对患者进行评估？一项试点研究

介绍

心电图 (ECG) 在急诊科 (ED) 的患者分类过程中经常进行。急诊医师 (EP) 在执行其他任务时会被打断以查看心电图。批评人士认为，这种做法可能会导致注意力分散，从而导致医疗错误和决策疲劳。

心电图可以在捕获时由计算机软件解释；一些证据表明，在 ED 分诊期间进行的 ECG 的即时计算机解释 (ICI) 为“正常”，很少会包含需要改变分诊管理的信息。

材料与方法

2017 年 7 月 13 日至 2018 年 7 月 12 日期间，在皇家德比医院对无胸痛且 ICI 为“正常”的患者进行的所有 ED 分类心电图均通过数据库搜索确定。40 人被随机选择并由两名 EP（对患者详细信息、ICI 和结果不知情）进行审查，他们被要求确定需要改变分类管理的那些。

结果

研究过程是可行的。两名 EP 审查员中至少有一名认为需要在 48% 的病例中改变分类管理（例如“审查患者”、“获取血气”、“审查旧的心电图”）；他们同意在 13% 的案例中需要改变管理层。正常 ICI 的 NPV 为 53%（95% CI 37-67%），需要根据心电图结果改变分类管理。观察者间的一致性很差（kappa = 0.17）。

结论

根据这些结果，无论 ICI 是什么，ED 分流 ECG 仍应提交给 EP 以供立即审查。EP 之间的观察者间一致性很差。需要进一步研究将分类心电图解释、干预需求和患者结果联系起来。