心电图解读用于判断溶栓 eligibility 时的观察者变异性：经验和背景很重要。注：这里“eligibility”直译为“资格、适宜性”等，结合语境大概是指判断是否适合溶栓的标准，翻译为“eligibility”稍显生硬，可根据具体医学背景灵活调整表述，比如“是否适宜溶栓” 。整体译文仅供参考，具体可根据医学专业知识进一步优化。

Observer variability in ECG interpretation for thrombolysis eligibility: experience and context matter.

作者信息

Massel David

机构信息

Department of Medicine, London Health Sciences Centre, University of Western Ontario, Room 205 Colborne Building, Victoria Campus, 375 South Street, London, Ontario, Canada N6A 4G5.

出版信息

J Thromb Thrombolysis. 2003 Jun;15(3):131-40. doi: 10.1023/B:THRO.0000011368.55165.97.

DOI:10.1023/B:THRO.0000011368.55165.97

PMID:14739622

Abstract

BACKGROUND

Despite the known benefit of thrombolysis it remains underutilized among eligible patients with acute myocardial infarction. We sought to determine whether potential errors in ECG interpretation might be a contributing factor and to what extent clinical history, a checklist outlining recognized inclusion criteria and a computerized interpretation would influence reliability and accuracy.

METHODS

Seventy-five ECGs were interpreted on 8 separate occasions by 9 clinicians (3 cardiologists, 3 cardiology fellows, 3 medical residents) according to a 2 x 2 x 2 factorial design.

RESULTS

The overall level of agreement among all raters was substantial with a kappa (kappa) of 70.4%. Intra-observer ECG reading reliability was stronger among cardiologists (CC) as compared with cardiology fellows (CF) and medical residents (MR). Similarly, inter-observer reliability was substantial to very good and a gradient was seen with greater reliability among CC, followed by CF, then MR ( P = 0.0013). CC recommended thrombolysis significantly more frequently ( p < 0.001) than either CF or MR. Trainees were biased by the presence of a computerized ECG interpretation resulting in a decision to recommend thrombolysis administration less often.

CONCLUSION

The reliability of ECG interpretation for deciding to administer thrombolysis was substantial; there was a gradient from lowest to highest commensurate with training and experience. Errors in thrombolysis eligibility are influenced by clinical history and the presence of a computerized ECG interpretation among less experienced clinicians.

摘要

背景

尽管已知溶栓治疗有益，但在符合条件的急性心肌梗死患者中，溶栓治疗的使用率仍然较低。我们试图确定心电图解读中的潜在错误是否可能是一个促成因素，以及临床病史、列出公认纳入标准的清单和计算机解读在多大程度上会影响可靠性和准确性。

方法

9名临床医生（3名心脏病专家、3名心脏病学研究员、3名住院医师）根据2×2×2析因设计，在8个不同场合对75份心电图进行解读。

结果

所有评估者之间的总体一致性水平较高，kappa值为70.4%。与心脏病学研究员（CF）和住院医师（MR）相比，心脏病专家（CC）的观察者内心电图解读可靠性更强。同样，观察者间的可靠性较高至非常高，并且观察到一种梯度，CC之间的可靠性更高，其次是CF，然后是MR（P = 0.0013）。CC推荐溶栓治疗的频率明显高于CF或MR（p < 0.001）。实习生受到计算机心电图解读的影响，导致推荐溶栓治疗的决定频率较低。