Abstract 236: Prevalence of ECG Recording Errors in a University Hospital ECG Database

Abstract

Background: Electrocardiographic recording can suffer from several potential errors which may impact their proper interpretation and patient care. Objective: To assess the prevalence of reported ECG errors in a university hospital database with a mix of inpatient and outpatient electrocardiograms (ECG). Methods: The first 1000 ECGs performed during one month were downloaded and individually analyzed for reported errors and artifacts. There were 237 (23.7%) outpatient ECGs and 763 (76.3%) inpatient or emergency department ECGs. The types of errors are reported as absolute numbers and as percentages of the total errors. Results: Among 1000 ECGs analyzed, 65 ECGs (6.5%) contained error or artifact statements. Among those, 15 ECGs (23.1%) were perceived precordial lead misplacements simulating anterior myocardial infarctions. There were 5 ECGs (7.7%) with lead reversals; 3 of which were precordial lead reversals (4.6%) and 2 were limb lead reversals (3.1%). A total of 45 ECGs (69.2%) contained baseline artifacts; 27 ECGs (41.5%) had AC noise artifacts, and 18 ECGs (27.7%) had baseline wander artifacts. Out of the total ECGs with reported errors, 60 ECGs (92.3%) were performed in the inpatient or emergency department setting, while 5 ECGs (7.7%) were performed in the outpatient setting. Discussion: Electrocardiography remains the cornerstone of early diagnosis and treatment of cardiac disease in the inpatient and outpatient setting. ECG recording artifacts have been reported with variable frequency, with inpatient recordings likely suffering greater errors, depending on the acuity of the situation. We observed that in the outpatient setting, there was 2.1% (5/237) prevalence of recording error, while in the inpatient and emergency department setting there was 7.9% (60/763) prevalence of ECG recording errors. Despite the overall small percentages, this is an alarming problem, especially with regards to inpatient ECGs when the results often prompt critical treatment decisions. The reason for the discrepancy between inpatient and outpatient ECG errors is not clear. Potential causes may include the intensity of the situation with compromise of proper lead placement, such as use of Mason-Likar configuration or placing leads above the left breast in female patients or unavailability of proper recording surfaces as in trauma or burn patients, but may also be caused by the lack of availability of adequately trained staff especially in the after-hour situations. Adequate training of staff to perform proper ECGs, and creation of robust electrocardiographic interpretation algorithms to recognize more recording errors on-screen before printing is called for.