[Level of agreement in the interpretation of electrocardiograms].

OBJECTIVE

To evaluate diagnostic concordance in the interpretation of electrocardiograms (ECG) between general practitioners and a referral cardiologist.

DESIGN

Crossover and descriptive.

SETTING

Seven General Medicine consulting rooms at Burgo de Osma Health Centre.

PATIENTS AND OTHER PARTICIPANTS

318 ECGs included and distributed at random among the doctors, from May 1992 to April 1993 (11 months). 28 were excluded for analysis.

MEASUREMENTS AND MAIN RESULTS

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.

CONCLUSIONS

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.