Accuracy of ECG interpretation among doctors working at the emergency medicine department of a tertiary hospital in Tanzania

Abstract

ABSTRACT Background: Electrocardiograms are widely used for diagnosing heart diseases, including myocardial ischemia, metabolic disturbances, and life-threatening arrhythmias. In the Emergency Medicine Department, the utilization and evaluation of electrocardiograms (ECGs) are vital for diagnosing and planning the treatment of patients with critical conditions. However, Errors in interpretation can cause significant morbidity and mortality, while over-interpretation can lead to unnecessary treatments, increasing costs and hospital stays. Objective of the study: To determine the accuracy of ECG interpretation among doctors working at the Emergency Medicine Department in a tertiary hospital, in Tanzania. Methodology: The study was conducted at Muhimbili National Hospital's Emergency Department in Tanzania (March-April 2024) and involved Emergency Medicine Residents and General Practitioners with specified experience. Participants provided consent, completed a survey, and interpreted ten anonymized ECGs. Accuracy was assessed 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 summarized using SPSS, calculating frequencies, percentages, means, standard deviations, medians, percentiles, and 95% confidence intervals. Results: The average ECG interpretation score among doctors in the Emergency Medicine Department was 59.4%. Mean scores for general practitioners, 1st, 2nd, and 3rd-year residents were 50.96%, 54.18%, 66.06%, and 66.43%, respectively. Bifascicular Block and Acute Pericarditis were the most challenging diagnoses. Overall, 51% of respondents reported good confidence, while 35.3% reported moderate confidence. There was a moderately strong positive correlation (rho = 0.532) between ECG scores and self-reported confidence. Conclusion: Enhanced ECG training and confidence-building are crucial for improving diagnostic accuracy and patient outcomes. Targeted training programs should be immediately implemented.