Dr ACCURACY OF ECG INTERPRETATION AMONG DOCTORS WORKING AT THE EMERGENCY MEDICINE DEPARTMENT OF A TERTIARY HOSPITAL IN TANZANIA

Abstract

Background: Electrocardiograms (ECGs) are essential tools for diagnosing and managing critically ill patients. Emergency Physicians must develop proficiency in ECG interpretation to ensure accurate patient assessment. Errors in interpretation can lead to significant morbidity and mortality, while over-interpretation can increase healthcare costs and prolong hospital stays. In Tanzania, there has been no formal assessment across different medical cadres to evaluate ECG interpretation accuracy, hindering the identification of common errors and challenges faced by General Practitioners (GPs) and residents.

Objective: This study aims to evaluate the accuracy of ECG interpretation among doctors working in the Emergency Medicine Department (EMD) at a tertiary hospital in Tanzania.

Methodology: Conducted at Muhimbili National Hospital's EMD between March and April 2024, this study involved Emergency Medicine Residents and General Practitioners. Participants provided informed consent, completed a survey, and interpreted ten anonymized ECGs. Accuracy was evaluated based on rate, rhythm, QRS axis, P wave, T wave, PR interval, QT interval, and primary diagnosis. Two specialists reviewed the ECGs, and a marking scheme was developed. Data were analyzed using SPSS, with calculations of frequencies, percentages, means, standard deviations, medians, percentiles, and 95% confidence intervals.

Results: The overall mean ECG interpretation score among EMD doctors was 59.4%. General Practitioners scored an average of 50.96%, while 1st, 2nd, and 3rd-year residents scored 54.18%, 66.06%, and 66.43%, respectively. The most challenging diagnoses were Bifascicular Block and Acute Pericarditis. While 51% of respondents reported good confidence in their ECG interpretation skills, 35.3% reported moderate confidence. There was a moderately strong positive correlation (rho = 0.532) between ECG scores and self-reported confidence levels.

Conclusion: The accuracy of ECG interpretation in the EMD was generally low, with improvement noted as training levels increased. Self-reported confidence also correlated with interpretation accuracy, highlighting the need for enhanced ECG training to improve both competence and confidence. General Practitioners and first-year residents had lower scores, while second and third-year residents performed better. Immediate implementation of targeted ECG training programs is recommended to enhance diagnostic accuracy and patient outcomes in the Emergency Medicine Department.