Evaluation of the efficacy of hand-held computer screens for cardiologists' interpretations of 12-lead electrocardiograms

Am Heart J. 1999 Oct;138(4 Pt 1):765-70. doi: 10.1016/s0002-8703(99)70194-8.


Background: Newly designed computer-based applications and the development of wireless technology have allowed the transmission of 12-lead electrocardiogram (ECG) waveforms from remote locations to the hand-held computers of cardiologists. If these computer ECGs can be reliably interpreted, then the time to treatment for cardiac patients may be reduced.

Methods and results: Twenty classic examples of cardiac abnormalities were chosen to test the efficacy of the hand-held computer's liquid crystal display (LCD) screen in the interpretation of 12-lead ECGs. Ten cardiologists interpreted these 20 ECGs on the hand-held computers and then twice later on traditional printed paper. The control intraobserver agreement between the sets of paper-displayed ECGs was measured against the agreement between each of the paper sets and the LCD-displayed set of ECGs. Eighty-nine percent (178/200) of the ECGs were interpreted identically by the participants between the 2 paper sets. When comparing the interpretations of the LCD-displayed ECGs with those of each of the paper sets of ECGs, 88.0% (176/200) and 87.5% (175/200) of identical diagnoses were noted. These differences of 1.0% and 1.5% in intraobserver agreement between paper-to-paper and each of the 2 paper-to-LCD comparisons were not significant (P =.75 and P =.88, respectively).

Conclusions: The strong intraobserver agreement shows that cardiologists make the same diagnoses when viewing LCD-displayed ECGs as they do when viewing paper-displayed ECGs. A study to measure the intraobserver agreement of the decision regarding administration of reperfusion therapy after interpretation of ECGs of patients with acute chest pain is now underway.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Data Display
  • Electrocardiography / instrumentation
  • Electrocardiography / methods*
  • Electrocardiography / statistics & numerical data
  • Heart Diseases / diagnosis*
  • Heart Diseases / epidemiology
  • Humans
  • Microcomputers*
  • Observer Variation
  • Telemedicine