Bogun Frank, Anh Daejoon, Kalahasty Gautham, Wissner Erik, Bou Serhal Chadi, Bazzi Rabih, Weaver W Douglas, Schuger Claudio
Division of Cardiology, Henry Ford Hospital, Detroit, Michigan, USA.
Am J Med. 2004 Nov 1;117(9):636-42. doi: 10.1016/j.amjmed.2004.06.024.
Computer algorithms are often used for cardiac rhythm interpretation and are subsequently corrected by an overreading physician. The purpose of this study was to assess the incidence and clinical consequences of misdiagnosis of atrial fibrillation based on a 12-lead electrocardiogram (ECG).
We retrieved 2298 ECGs with the computerized interpretation of atrial fibrillation from 1085 patients. The ECGs were reinterpreted to determine the accuracy of the interpretation. In patients in whom the interpretation was incorrect, we reviewed the medical records to assess the clinical consequences resulting from misdiagnosis.
We found that 442 ECGs (19%) from 382 (35%) of the 1085 patients had been incorrectly interpreted as atrial fibrillation by the computer algorithm. In 92 patients (24%), the physician ordering the ECG had failed to correct the inaccurate interpretation, resulting in change in management and initiation of inappropriate treatment, including antiarrhythmic medications and anticoagulation in 39 patients (10%), as well as unnecessary additional diagnostic testing in 90 patients (24%). A final diagnosis of paroxysmal atrial fibrillation based on the initial incorrect interpretation of the ECGs was generated in 43 patients (11%).
Incorrect computerized interpretation of atrial fibrillation, combined with the failure of the ordering physician to correct the erroneous interpretation, can result in the initiation of unnecessary, potentially harmful medical treatment as well as inappropriate use of medical resources. Greater efforts should be directed toward educating physicians about the electrocardiographic appearance of atrial dysrhythmias and in the recognition of confounding artifacts.
计算机算法常用于心律解读，随后由审阅医生进行校正。本研究的目的是基于12导联心电图（ECG）评估房颤误诊的发生率及临床后果。
我们从1085例患者中检索出2298份经计算机解读为房颤的心电图。对这些心电图重新解读以确定解读的准确性。对于解读错误的患者，我们查阅病历以评估误诊导致的临床后果。
我们发现，1085例患者中的382例（35%）的442份心电图（19%）被计算机算法错误解读为房颤。在92例患者（24%）中，开具心电图检查的医生未能纠正不准确的解读，导致治疗方案改变并开始了不适当的治疗，包括39例患者（10%）使用抗心律失常药物和抗凝治疗，以及90例患者（24%）进行不必要的额外诊断检查。基于最初对心电图的错误解读最终诊断为阵发性房颤的患者有43例（11%）。
房颤的计算机解读错误，加上开具检查的医生未能纠正错误解读，可能导致开始不必要的、潜在有害的医疗治疗以及医疗资源的不当使用。应加大力度对医生进行有关房性心律失常心电图表现及识别混淆伪差方面的教育。
