Mount Sinai School of Medicine, Department of Emergency Medicine, New York University, United States of America.
Mount Sinai School of Medicine, Department of Emergency Medicine, New York University, United States of America.
Am J Emerg Med. 2020 Jan;38(1):18-22. doi: 10.1016/j.ajem.2019.03.048. Epub 2019 Mar 29.
To determine whether a checklist of possible etiologies for syncope provided alongside ECGs helps Emergency Medicine (EM) residents identify ECG patterns more accurately than with ECGs alone.
We developed a test of ten ECGs with syncope-related pathology from ECG Wave-Maven. We reviewed the literature and used expert consensus to develop a checklist of syncope-related pathologies commonly seen and diagnosed on ECGs. We randomized residents from three New York EM residency programs to interpret ECGs with or without a checklist embedded into the test.
We randomized 165 residents and received completed tests from 100 (60%). Of those who responded, 39% were interns, 23% PGY2s, and 38% were PGY3s or PGY4s. We found no significant difference in overall test scores between those who read ECGs with a checklist and those who read ECGs alone. In post-hoc analysis, residents given a checklist of syncoperelated etiologies were significantly more likely to recognize Brugada (96% vs. 78%, p = 0.007), long QT (86% vs. 68%, p = 0.03) and heart block (100% vs 78%, p = 0.003) as compared to those without a checklist. Those with a checklist were more likely to overread normal ECGs (72% vs 35%, p = 0.0001) compared to those without a checklist, finding pathology where there was none.
Using a checklist with common syncope-related pathology when interpreting an ECG for a patient with clinical scenario of syncope may improve residents' ability to recognize some clinically important pathologies; however it could lead to increased interpretation and suspicion of pathology that is not present.
确定在心电图旁边提供晕厥可能病因清单是否有助于急诊医学（EM）住院医师比单独使用心电图更准确地识别心电图模式。
我们从 ECG Wave-Maven 中开发了一个包含与晕厥相关病理学的十份心电图测试。我们回顾了文献并利用专家共识制定了一个常见的晕厥相关病理学检查表，这些病理学通常在心电图上看到和诊断。我们将来自纽约三个急诊医学住院医师培训计划的住院医师随机分配到有或没有嵌入测试中的检查表的心电图进行解释。
我们随机分配了 165 名住院医师，收到了 100 名（60%）完成的测试。在做出回应的人中，39%是实习生，23%是 PGY2，38%是 PGY3 或 PGY4。我们没有发现阅读有检查表和没有检查表的心电图的总测试分数之间有显著差异。在事后分析中，与没有检查表的住院医师相比，给予晕厥相关病因检查表的住院医师更有可能识别 Brugada（96%对 78%，p=0.007）、长 QT（86%对 68%，p=0.03）和心脏阻滞（100%对 78%，p=0.003）。与没有检查表的住院医师相比，那些有检查表的住院医师更有可能过度解读正常心电图（72%对 35%，p=0.0001），在没有病理学的情况下发现病理学。
在为具有晕厥临床情况的患者解释心电图时，使用常见晕厥相关病理学的检查表可能会提高住院医师识别一些临床重要病理学的能力；然而，它可能导致对不存在的病理学的解释和怀疑增加。
