Missed myocardial ischaemia in the accident & emergency department: E.C.G. a need for audit?

Arch Emerg Med. 1991 Jun;8(2):102-7. doi: 10.1136/emj.8.2.102.


Accident & Emergency Department Senior House Officers rely heavily on their ECG interpretation skills in the diagnosis and management of patients with chest pain. This prospective double-blind study was designed to test the accuracy with which Accident & Emergency Senior House Officers interpret ECGs, by comparing their interpretation with that of a Consultant Cardiologist. ECGs from 279 of 314 consecutive patients with chest pain were analysed. Ninety per cent of normal electrocardiographs and 57% of abnormal ECGs were correctly interpreted. Despite the inaccurate interpretation of 43% of abnormal ECGs, 96.5% of the patients in the study were considered to have been managed correctly. Audit of all ECGs recorded in the Accident & Emergency Department should be undertaken by someone with experience of ECG interpretation. New A&E staff should receive training in the interpretation of ECGs.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial

MeSH terms

  • Cardiology / standards
  • Diagnostic Errors
  • Double-Blind Method
  • Electrocardiography / standards*
  • Emergency Medicine / education
  • Emergency Medicine / standards*
  • Emergency Service, Hospital / standards
  • Female
  • Humans
  • Male
  • Medical Audit
  • Middle Aged
  • Myocardial Infarction / diagnosis*
  • Myocardial Infarction / epidemiology
  • Northern Ireland / epidemiology
  • Predictive Value of Tests
  • Prospective Studies