Digitally Transmitted ECG’s Viewed on a Large Screen Does Not Improve Correct STEMI Diagnosis Compared to Print/Scan/Fax ECG’s Viewed on a Handheld device
Presenter
Natali Sorajja, BA, Department of Cardiovascular Medicine, University of Wisconsin-Madison, Madison, WI
Natali Sorajja, BA, Megan Walusiak, Benjamin R Ciske, MD, Amy Shepard, RN, Fauzia Osman, MPH, Gregory A Tester, MD, Marcus G Sublette, MD, Ruben Alexanian, MD, David H Lewis, MD, Kurt M Jacobson, MD, FSCAI, Giorgio Gimelli, MD, FSCAI and Amish N. Raval, MD, Department of Cardiovascular Medicine, University of Wisconsin-Madison, Madison, WI
Keywords: Acute Coronary Syndromes (ACS), Adult Congenital Heart Disease (ACHD), Coronary and Quality
Background
Rapid diagnosis of ST-elevation myocardial infarction (STEMI) is critical for patient survival. At our institution, the field ECG is either digitally transmitted direct to interventional cardiologists (ICs) or it is printed, scanned and faxed to an email address. The latter transmission method often suffers decay in the image resolution. The ECG is reviewed by ICs on a large desktop/laptop screen or small handheld device screen. Little is known about the impact of ECG transmission method and screen size for making an accurate STEMI diagnosis. We hypothesized that the i) method of ECG transmission and ii) size of image display could influence ECG interpretation of STEMI.
Methods
Six ICs reviewed 60 anonymized and never before reviewed ECGs on a laptop (n=30) and cell phone (n=30). 43 confirmed STEMI ECGs were randomly mixed with 17 confirmed non-STEMI ECGs, based on AHA/ACC STEMI ECG criteria and independent review of the medical record/cardiac cath films. Each IC was asked whether they would activate or not activate a direct-to-Cardiac Cath Lab STEMI protocol based solely on their ECG interpretation. Since the decision to activate the STEMI protocol could vary based on individual risk aversion, each IC completed a Holt-Laury risk aversion questionnaire. Correctness of STEMI diagnosis and ECG interpretation was correlated using 4 variables (Print/Scan/Fax vs. Direct and Small Screen vs. Large Screen).
Results
IC interpretation of digitally transmitted ECG’s correlated with accurate STEMI diagnosis to a greater but non-statistically significant extent compared to ECG’s transmitted by print/scan/fax (79% and 65%, respectively; ANOVA p-value = 0.11). STEMI ECG interpretation accuracy was 73% for both the cell phone and laptop displays (p=NS).
Conclusions
Although direct digital ECG transmission can lead to more rapid STEMI diagnosis and activation of the direct-to-Cardiac Cath Lab STEMI protocol, this approach was associated with similar ECG interpretation accuracy compared to print/scan/fax transmitted ECGs. Similarly, reviewing ECG’s on small screen hand-held devices resulted in similar interpretation accuracy compared to reviewing ECGs on large screens.