Errors in emergency physician interpretation of ST-segment elevation in emergency department chest pain patients

Objective: To determine the rate of error in emergency physician (EP) inter pretation of the cause of electrocardiographic (ECG) ST-segment elevation ( STE) in adult chest pain patients. Methods: The authors conducted a retrosp ective ECG review of adult chest pain patients in a university hospital eme rgency department (ED) over a three-month period (January 1 to March 31, 19 96). ST-segment elevation was determined to be present if the ST segment wa s elevated greater than or equal to1 mm in the limb leads and greater than or equal to2 mm in the precordial leads in at least two anatomically contig uous leads. Initial EP ECG interpretation was compared with the final inter pretation by a cardiologist supported by the results of various clinical in vestigations. The rate of incorrect ECG diagnosis was calculated. Results: Two hundred two patients had STEs. The rate of ECG STE misinterpretation wa s 12 of 202 (5.9%). The most frequently misdiagnosed form of STE was left v entricular aneurysm, for which two of five cases were believed to represent acute myocardial infarction (AMI). The benign early repolarization (BER) p attern was the second most frequently misinterpreted STE entity-in a total of three cases, two were initially noted to represent pericarditis and one AMI. ST-segment elevation resulting from actual AMI was initially incorrect ly noted to be noninfarction in etiology in two cases, one patient with BER and the other with left ventricular hypertrophy. Conclusions: Emergency ph ysicians show a low rate of ECG misinterpretation in the patient with chest pain and STE. The clinical consequences of this misinterpretation are mini mal.