Inter-Rater Reliability of ST-Segment Measurement at a University Hospital in Argentina
American Journal of Internal Medicine
Volume 7, Issue 1, January 2019, Pages: 5-8
Received: Dec. 14, 2018; Accepted: Jan. 15, 2019; Published: Jan. 31, 2019
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Ignacio Martín Santarelli, Department of Medicine, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
Diego Costa, Cardiovascular Intensive Care Unit, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
Sandra Swieszkowski, Cardiovascular Intensive Care Unit, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
Ricardo Perez de La Hoz, Cardiovascular Intensive Care Unit, Hospital de Clínicas “José de San Martín”, Buenos Aires, Argentina
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The accurate determination of the electrocardiographic ST-segment elevation in a patient with clinical suspicion of acute coronary syndrome is essential for treatment with urgent myocardial reperfusion. The aim of this study was to determine the inter-rater reliability of ischemic and non-ischemic ST-segment elevation measurement among physicians with different specialties and experience. We performed an observational, cross-sectional study, with a comparative correlation and paired sampling. 56 physicians from a university hospital in Buenos Aires city were included: Cardiologists from the Coronary Care Unit (CCU) and Cardiology Division, Internal Medicine physicians from the hospitalization, ambulatory care and Emergency divisions, and third- and fourth-year Internal Medicine residents. Each participant analyzed 6 electrocardiograms and was asked to determine the magnitude of the ST-segment elevation at the J-point, and the corresponding diagnosis. The inter-rater coefficient was lower than 0.2, and the global kappa coefficient was 0.06 (p < 0.001). The global correct interpretations were: inferior wall myocardial infarction (MI): 89.3%; anterior wall MI: 51.8%; lateral wall MI: 75%; left bundle branch block: 91.1%; left ventricle hypertrophy: 44.6%; acute pericarditis: 25%. We believe that the low correlation was probably due to the difficulty in determining the J-point. These findings could suggest the need to strengthen the electrocardiographic concepts of ischemia, and the differentiation between ischemic and non-ischemic ST-segment elevations.
J Point, Electrocardiogram, Ischemia, Infarct, ST Segment
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Ignacio Martín Santarelli, Diego Costa, Sandra Swieszkowski, Ricardo Perez de La Hoz, Inter-Rater Reliability of ST-Segment Measurement at a University Hospital in Argentina, American Journal of Internal Medicine. Vol. 7, No. 1, 2019, pp. 5-8. doi: 10.11648/j.ajim.20190701.12
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