Why the study?
Anatomical misplacement of ECG electrodes is common and significantly impacts clinical diagnosis, prompting a review of its effects on ECG morphology, diagnosis, patient outcomes, and safety.
Does accurate anatomical placement of ECG electrodes improve clinical diagnosis in adult patients compared to misplaced electrodes?
Does accurate anatomical placement of ECG electrodes improve clinical diagnosis in adult patients compared to misplaced electrodes?
Correct anatomical placement of ECG electrodes is essential to prevent altered ECG morphology and subsequent clinical misdiagnosis, highlighting the need for mandatory peer-led training.
Accurate precordial electrode placement is mandatory to avert ECG misdiagnosis and inappropriate therapy; confirms positioning errors as a modifiable, high-impact source of diagnostic inaccuracy.
Abstract Background: Anatomical misplacement of the Electrocardiogram (ECG) electrode(s) is common, with significant impact on clinical diagnosis. Reasons are multi-faceted, with this review examining the consequential effects of misplacement to ECG morphology, diagnosis, prognosis, patient outcomes, and potential impact to patient care pathway. Objectives: This review examined the significance of misplacement, its’ commonality and ensuing effect on patient safety, accurate ECG acquisition and diagnosis, with evaluation of reasons for such misplacement.Methodology: Review of available literature was conducted using electronic databases. In-line with the Preferred Reporting Items for Systematic reviews and Meta – analysis protocols (PRISMA) 2015 checklist, this review was conducted with search criteria, search terms, eligibility for inclusion/ exclusion criteria, extraction and data analysis predetermined by the authors. Keywords were arranged according to grouping of terms surrounding ECG, anatomical placement, and diagnosis. The search strategy was conducted during September/October 2019. Scoping searches were conducted alongside reference lists of included studies hand searched (Snowballing) for further relevant studies. The Critical Appraisal Skills Programme (CASP) was used to methodically appraise papers (CASP, 2019). Screening of titles and abstracts of identified citations was performed by a single reviewer. Eligible articles then full text screened independently by two reviewers. Disagreements were discussed and resolved by a third reviewer. In instances of unclear reporting, authors were contacted to provide further information and clarity. Assessment of relevant literature and critical appraisal of primary research, pertaining to the clinical diagnosis and effects of anatomical misplacement of ECG electrodes, formulate the thematic discussion drawn by this review. Results: This review identified a plethora of causes, ranging from: operator error; lack of anatomical awareness; inaccurate assessment of anatomical landmarks; obesity; differences in anatomy/gender; levels of undress and lack of appreciation of consequences of misplacement, both modifiable and non-modifiable attributable to electrode misplacement. Clinical diagnosis can be altered owing to erroneous placement of electrodes. ECG morphology is altered due to incorrect anatomical misplacement, culminating substandard practice, a missed diagnosis or misdiagnosis and potential harm. Conclusion: Correct anatomical placement of ECG electrodes is essential to diagnosis in the clinical setting. Peer-led educational intervention with mandatory training is essential to improve practice. PROSPERO Registration Number: CRD42019152461
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Alexandros Stavros Hadjiantoni (2020) studied this question.
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