Emergency Physician Interpretation of Prehospital, Paramedic-Acquired Electrocardiograms

Hypothesis: Emergency physician interpretation of prehospital, paramedic-acquired, electrocardiograms (ECG) is accurate judged by comparison with that of a reference cardiologist. Methods: Twelve-lead ECGs were obtained by paramedics in the field from 150 patients with acute chest pain. The ECGs were transmitted by cellular telephone to a central location. Each ECG was assessed for evidence of acute myocardial infarction (AMI) by: 1) a third-year, emergency medicine resident (EMP-R); 2) a residency-trained, board-certified, emergency physician (EMP-RT); 3) an emergency physician board certified under the practice option (EMP-PT); and 4) a board-certified cardiologist. Agreement between each emergency physician and the cardiologist was assessed by the kappa statistic. Hospital records were reviewed for final diagnosis of each patient. Results: Sixteen of 150 (10.7%) patients received a hospital discharge diagnosis of AMI. Sensitivity of physician interpretation ranged from 0.31 to 0.56. All physicians achieved specificity of 0.99. False-positive rates for the physicians ranged from 0.18–0.29. The mean positive predictive value for the four physicians was 0.77±0.05; the mean negative predictive value was 0.94±0.01. The total agreements between the EMP-R, EMP-RT, and EMP-PT and the cardiologists were 0.97, 0.96, and 0.97, respectively. Kappa values for agreement between the emergency physicians and the cardiologist ranged from 0.65–0.79. Conclusions: Residency-trained or board-certified emergency physician interpretations of prehospital, paramedic-acquired 12-lead ECGs show a high degree of agreement with reference cardiologist interpretations.