Moreno Castillo A, Iglesias Gómez P, Arbesu Fernández E
Centro de Salud de Burgo de Osma, Soria.
Aten Primaria. 1995 Sep 15;16(4):187-91.
To evaluate diagnostic concordance in the interpretation of electrocardiograms (ECG) between general practitioners and a referral cardiologist.
Crossover and descriptive.
Seven General Medicine consulting rooms at Burgo de Osma Health Centre.
318 ECGs included and distributed at random among the doctors, from May 1992 to April 1993 (11 months). 28 were excluded for analysis.
The proportion of agreement observed (Po) and the Kappa (K) index were obtained. Po was > 90% in all diagnostic categories, except normality (76.5%). Overall K was 0.52 (C.I. 95%: 0.50-0.54); K = 0.79 in disturbances in frequency; K = 0.52 in diagnosis of normality; K = 0.46 in disturbances of rhythm; K = 0.38 in ventricular conduction disorders; K = 0.36 in repolarisation disturbances; K = 0.32 for disorders of the auricular-ventricular union; K = 0.17 for unspecific disorders and K = 0.07 for auricular disturbances.
Overall concordance is acceptable, as it is for normality and rhythm and frequency disturbances; for the remaining diagnostic categories it was light or ordinary. The Primary Care team (PCT) in comparison with the cardiologist underdiagnosed the frequency and a-v union disorders and overdiagnosed the unspecific disorders. The PCT must improve in their diagnoses of greater prevalence and low K value.
评估全科医生与转诊心脏病专家在心电图（ECG）解读方面的诊断一致性。
交叉和描述性研究。
布尔戈斯德奥斯马健康中心的七个普通内科诊室。
1992年5月至1993年4月（11个月）期间纳入318份ECG，并随机分发给医生。28份被排除用于分析。
得出观察到的一致性比例（Po）和卡帕（K）指数。除正常情况（76.5%）外，所有诊断类别中的Po均>90%。总体K值为0.52（95%置信区间：0.50 - 0.54）；频率紊乱时K = 0.79；正常诊断时K = 0.52；节律紊乱时K = 0.46；心室传导障碍时K = 0.38；复极紊乱时K = 0.36；房室连接障碍时K = 0.32；非特异性障碍时K = 0.17；心房紊乱时K = 0.07。
总体一致性是可接受的，正常情况以及节律和频率紊乱的一致性也是如此；对于其余诊断类别，一致性为轻度或一般。与心脏病专家相比，初级保健团队（PCT）对频率和房室连接障碍诊断不足，对非特异性障碍诊断过度。PCT必须在患病率较高且K值较低的诊断方面有所改进。
