Hillson S D, Connelly D P, Liu Y
Department of Medicine, Ramsey Clinic, St. Paul, MN 55101, USA.
Med Decis Making. 1995 Apr-Jun;15(2):107-12. doi: 10.1177/0272989X9501500202.
To evaluate the effect of computer-assisted interpretation of electrocardiograms (ECGs) on diagnostic decision making by primary care physicians.
Randomized controlled trial.
Primary care physicians' outpatient clinics in or near the Minneapolis/St. Paul metropolitan area.
Forty family physicians and general internists who were members of either of two large consortia of clinics.
Subjects evaluated ten clinical vignettes accompanied by ECGs and reported their diagnostic impressions. The vignettes were based on actual patient visits. Half of the subjects received ECGs with computer-generated reports, the other half received the same ECGs without reports.
ECG reading time; agreement with the clinical diagnosis; agreement with the computer report; diagnostic confidence.
The subjects receiving the reports were more likely to agree with the clinical diagnoses of the original cases, particularly for two vignettes in which the diagnoses were uncommon and were mentioned in the reports. The subjects receiving the reports were also more likely to make diagnoses that were consistent with the reports, even when the reports were erroneous. Those receiving the reports spent, on average, 15 seconds less time looking at each ECG, a 25% decrease.
In simulated cases, primary care physicians appear to use computer interpretations of ECGs when available, as shown by enhanced diagnostic accuracy and modestly reduced time spent reading the tracings. However, erroneous reports may mislead physicians. Since the effects of computerized ECG interpretation do not appear to have been uniformly favorable in this mock-clinical setting, it will be important to evaluate the effects of this technology in actual practice.
评估计算机辅助解读心电图（ECG）对初级保健医生诊断决策的影响。
随机对照试验。
明尼阿波利斯/圣保罗大都市地区或附近的初级保健医生门诊。
40名家庭医生和普通内科医生，他们是两个大型诊所联盟之一的成员。
受试者评估十个伴有心电图的临床病例，并报告他们的诊断印象。这些病例基于实际患者就诊情况。一半受试者收到带有计算机生成报告的心电图，另一半收到相同的无报告心电图。
心电图阅读时间；与临床诊断的一致性；与计算机报告的一致性；诊断信心。
收到报告的受试者更有可能认同原始病例的临床诊断，特别是对于两份诊断不常见且在报告中提及的病例。即使报告有误，收到报告的受试者也更有可能做出与报告一致的诊断。收到报告的受试者平均看每份心电图的时间少了15秒，减少了25%。
在模拟病例中，初级保健医生在有计算机解读的心电图时似乎会加以利用，这表现为诊断准确性提高以及阅读心电图的时间适度减少。然而，错误的报告可能会误导医生。由于在这种模拟临床环境中计算机化心电图解读的效果似乎并非一律有利，因此评估该技术在实际临床中的效果非常重要。
