Concordancia en interpretación electrocardiográfica en síndromes coronarios agudos entre especialistas del servicio de urgencias y cardiólogos


Autoria(s): Camargo Castro, William Andres; Caicedo Arbelaez, Felipe
Contribuinte(s)

Isaza Restrepo, Daniel

Data(s)

12/08/2013

Resumo

Introducción: El ECG es una herramienta básica en el estudio del dolor torácico, no hay evidencia que demuestre si la interpretación electrocardiográfica de los especialistas de medicina interna y emergencias es similar a la de cardiólogos en casos de SCA. El propósito de este estudio es determinar si existe concordancia en interpretación de los hallazgos electrocardiográficos más frecuentes en la fase aguda de los síndromes coronarios. Metodología: Estudio retrospectivo de concordancia diagnóstica electrocardiográfica, realizado en un hospital universitario de cuarto nivel. Se escogieron los hallazgos electrocardiográficos más frecuentes en síndromes coronarios agudos para ser evaluados por 3 diferentes especialidades y se hizo el análisis de concordancia mediante el cálculo estadístico kappa. Resultados: Se analizaron 200 electrocardiogramas aleatorizados, de pacientes con SCA entre noviembre de 2012 a abril de 2013. La edad promedio fue 65,14 años, la mayoría hombres (62,5%), la hipertensión arterial y enfermedad coronaria fueron las comorbilidades más frecuentes. Se encontró un grado de concordancia moderada (k = 0.61 – 0.80, p <0.001) entre cardiólogos vs emergenciólogos y cardiólogos vs internistas, excepto en lesión subendocárdica (k = 0.11 y 0.24 respectivamente), hubo un grado de concordancia débil (k = 0.41 – 0.60, p <0.001) entre emergenciólogos e internistas. El hallazgo en el que hubo grado de concordancia muy bueno (k > 0.81) fue bloqueo de rama izquierda. Conclusión: Existe grado de concordancia moderada en la lectura electrocardiográfica en la mayoría de variables en relación con síndrome coronario agudo entre los especialistas de medicina interna y emergencias al compararlo con cardiólogos.

The electrocardiogram is a basic tool in the study of chest pain, there is no evidence that probes if the electrocardiographic interpretation of the emergency medicine and internal medicine specialist are similar to the cardiologist in cases of ACS. The purpose of this study is to determine if there is concordance between the interpretation of the most frequent electrocardiographic findings in the acute phase of the coronary syndromes. Methods: Retrospective study of diagnostic electrocardiographic concordance performed in a fourth level university hospital. The most frequent electrocardiographic findings in acute coronary syndrome were chosen to be evaluated by three different specialties and the concordance analysis were carried out through a kappa statistical analysis. Results: 200 randomized electrocardiograms of patients with acute coronary syndrome were analyzed between November of 2012 to April of 2013. The average age of the patients were 65 years, the male population were greater (62,5%), the most frequent comorbidities were high blood pressure and coronary disease. The concordance between cardiologist vs emergency medicine specialist and cardiologist vs internal medicine were moderated (k= 0.61 -0.80, p <0,001) except in subendocardic injury (k = 0.11 y 0.24 respectively), there were a weak concordance level between emergency medicine and internal medicine (k = 0.41 – 0.60, p <0.001). The best level of concordance found in the study were the left branch blockage (k > 0.81). Conclusion: There is a moderated degree of concordance level in the electrocardiographic interpretation in the majority of variables in the cases of acute coronary syndromes among the specialist in internal medicine and emergency medicine compared with cardiologists.

Formato

application/pdf

Identificador

http://repository.urosario.edu.co/handle/10336/4628

Idioma(s)

spa

Publicador

Facultad de Medicina

Direitos

info:eu-repo/semantics/openAccess

Fonte

reponame:Repositorio Institucional EdocUR

instname:Universidad del Rosario

1. Thygesen K, Alpert JS, Jaffe A. Third Universal Definition of Myocardial Infarction. Circulation. 2012;126:1-16

2. Snoey ER, Housset B. Analysis of emergency department interpretation of Electrocardiograms. J Acc Emerg Med. 1994;11:149-153

3. Eken C, Goksu E. The consistency of emergency physician’s and cardiologist’s ECG interpretation and likelihood classification of chest pain patients. Int J Clin Pract. 2006;60(10):1194–1197

4. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal. 2011;32:2999–3054

5. AHA/ACCF/HRS Recommendations for the Standardization and Interpretation of the Electrocardiogram: Part VI: Acute Ischemia/Infarction. Circulation. 2009;119:e262-e270

6. Westdrop EJ, Gratton MC, Watson WA. Emergency department interpretation of electrocardiograms. Ann Emerg Med. 1992;21(5):541-4

7. Bouida W, Dridi Z, Nouira S. Evaluation of electrocardiogram’s interpretation in the emergency department. Tunis Med. 2004;82:358–62

8. Jayes RL, Larsen GC, Beshansky JR. Physician electrocardiogram reading in the emergency department: accuracy and effect on triage decisions: findings from a multicenter study. J Gen Intern Med. 1992;7:387–92.

9. Brady WJ, Perron A. Errors in Emergency Physician Interpretation of ST-segment Elevation in Emergency Department Chest Pain Patients. Acad Emerg Med. 2000;7(11):1256-60

10. Sharkey SW, Berger CR, Brunette DD. Impact of the electrocardiogram on the delivery of thrombolytic therapy for acute myocardial infarction. Am J Cardiol. 1994;73:550–3.

11. Morris F, Brady WJ. ABC of clinical electrocardiography. Acute myocardial infarction—Part I. BMJ. 2002;324:831-834

12. Edhouse J, Brady WJ. ABC of clinical electrocardiography. Acute myocardial infarction—Part II. BMJ. 2002;324:963-966

13. Sabatine MS, Cannon CP. Chapter 53 – Approach to the Patient with Chest Pain. En: Bonow: Braunwald's Heart Disease - A Textbook of Cardiovascular Medicine, 9th ed. Saunders; 2011.

14. Yiadom MY. Emergency Department Treatment of Acute Coronary Syndromes. Emerg Med Clin N Am. 2011;29:699–710

15. Chapter 8 – Myocardial Infarction and Ischemia: ST Segment Elevation and Q Wave Syndromes. En: Goldberger: Clinical Electrocardiography: A Simplified Approach, 8th ed. Saunders. 2012

16. Gurm HS, Topol EJ. The ECG in acute coronary syndromes: new tricks from an old dog. Heart 2005;91:851–853

17. Berger A, Meier JM. ECG interpretation during the acute phase of coronary syndromes: in need of improvement?. Swiss Med Wkly 2004;134:695–699

18. Berger JS. Competency in electrocardiogram interpretation among internal medicine and emergency medicine residents. Am J Med. 2005;118:873–880

19. Boersma E, Maas AC, DeckersJW. Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. Lancet 1996;348:771–775

20. Salerno SM, Alguire PC, Waxman HS. Competency in interpretation of 12-lead electrocardiograms: a summary and appraisal of published evidence. Ann Intern Med 2005;138:751–760

21. Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet 1997;349:1498–1504

22. Guías colombianas de cardiología Síndrome coronario agudo con elevación del ST. Rev Col Card. 2010;17(Sup3):121-276

23. Gómez EA. El electrocardiograma en síndromes coronarios agudos. En: Urgencia Cardiovascular, manual de diagnóstico y tratamiento. 3ra Ed 2003.

24. Altman DG: Practical Statistics for Medical Research. Chapman and Hall, London, 1991

25. Holmwang L, Hasbak P, Clemmensen P, Wagner G, GrandeP. Differences between local investigator and core-laboratory interpretation of the admission electrocardiogram in patients with unstable angina pectoris or non-Q-wave myocardial infarction. Am J Cardiol. 1998;82:54-60.

26. Brady WJ, Perron AD, Martin ML, Beagle C, Aufderheide TP. Cause of ST segment abnormality in ED chest pain patients. Am J Emerg Med 2001;19:25–8

27. Lau J, Ioannidis JP, Balk EM, Milch C, Terrin N, Chew PW. Diagnosing acute cardiac ischemia in the emergency department: a systematic review of the accuracy and clinical effect of current technologies. Ann Emerg Med 2001;37:453–60.

28. S Goodacre, A Webster, F Morris. Do computer generated ECG reports improve interpretation by accident and emergency senior house officers? Postgrad Med J 2001;77:455–457

Palavras-Chave #CARDIOLOGÍA - INVESTIGACIONES #MEDICINA DE URGENCIAS - INVESTIGACIONES #ELECTROCARDIOGRAFÍA - UTILIZACIÓN #SÍNDROME CORONARIO AGUDO - ULTRASONOGRAFÍA #SÍNDROME CORONARIO AGUDO - DIAGNÓSTICO #concordance #electrocardiogram
Tipo

info:eu-repo/semantics/bachelorThesis

info:eu-repo/semantics/acceptedVersion