Evaluation de la qualité d'interprétation de l'électrocardiogramme préopératoire par les médecins anesthésistes

Abstract

This prospective study aimed to assess the quality of interpretation by Teaching Hospital anaesthesiologists of preoperative electrocardiograms (ECG). It was carried out over a period of 7 months, and included 500 patients scheduled for elective surgery. The ECG was first interpreted by the anaesthesiologist during the preoperative visit, and later during the postoperative period, by a cardiologist. The two interpretations were compared using the following criteria : minor anomalies, which would not influence the anaesthetic technique already selected ; major anomalies, which, on the other hand, are known to increase anaesthetic morbidity and mortality rates, thereby influencing the choice of anaesthetic technique ; and interpretative errors concerning only the major anomalies, i.e. anomalies not seen by the anaesthesiologist (false negatives), anomalies found which did not exist (false positives), and erroneous or incomplete interpretation. Interpretation of the ECG by the anaesthesiologist was written on the anaesthetic record for only 156 patients (31.2 %). Among the 500 ECG's, 141 were found to be abnormal by the cardiologist (28.2 %). Seventy-three of them had 1 or more major abnormalities. Of the 156 ECG's interpreted by an anaesthesiologist, 64 (41 %) were abnormal. The overall error rate was 21.1 %, the major error rate being 7.1 %. The overall false negative rate was 12.8 %, with 7 major ischaemic abnormalities (4.5 %) having not been found, including 4 (2.6 %) diagnostic errors. About 3.8 % of ECG's were wrongly interpreted as abnormal by the anaesthesiologist ; all errors were of minor importance, but nevertheless responsible for delayed surgery, loss of time, and extra expenditure in laboratory tests. The quality of interpretation of preoperative ECG by anaesthesiologists from a Teaching Hospital would therefore seem to be comparable to that of 1825 american residents sub-specialising in cardiology.