Many patients present to emergency departments (ED) in U.S. for evaluation of acute
coronary syndrome, and a rapid electrocardiogram (ECG) and interpretation are imperative
for initial triage. A growing number of advanced practice practitioners (APP) (e.g.
physician assistants, nurse practitioners) are assisting patient care in the ED.
This study aims to compare the interpretation of ECGs by experienced APPs, each having
10 or more years of experience, with resident physicians and attending physicians.
Patients and methods
99 ED providers were stratified into attendings, residents at varying levels, and
APPs were tested to interpret 36 ECGs from a database of ECGs initially interpreted
to be ST elevation myocardial infarctions, of which 24 were determined to have a culprit
lesion by coronary intervention.
Attending physicians were the most sensitive (0.86, 95% CI of 0.80 to 0.92) and specific
(0.69, 95% Cl of 0.60 to 0.79) at interpreting ECGs, but APPs and physicians in their
first year of practice out of residency were almost equally as sensitive [(0.82, 95%
CI of 0.76 to 0.88) and (0.82, 95% CI of 0.76 to 0.88)] and specific [(0.62, 95% cl
of 0.52 to 0.73) and (0.65, 95% Cl of 0.56 to 0.75)].
This study suggests the possibility of changing ED workflow where experienced APPs
can be responsible for initial screening of an ECG, thus allowing fewer interruptions
for ED physicians.