The diagnosis of myocardial infarction in critically ill patients: An agreement study |
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| Authors: | Wendy Lim MD MSc Andrea Tkaczyk RN MN Paula Holinski MD Ismael Qushmaq MD Michael Jacka MD Vikas Khera MD P.J. Devereaux MD PhD Irene Terrenato PhD Holger Schunemann MD PhD Diane Heels-Ansdell MSc Mark Crowther MD MSc Deborah Cook MD MSc |
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| Affiliation: | aDepartment of Medicine, McMaster University, Hamilton, Ontario, Canada;bDepartment of Clinical Epidemiology and Biostatistics, McMaster University, Canada;cDepartment of Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia;dDepartment of Medicine, University of Alberta, Edmonton, Alberta, Canada;eDepartment of Epidemiology, Italian National Cancer Institute Regina Elena, Rome, Italy |
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| Abstract: | PurposeThe aim of the study was to assess agreement among 4 intensivists in diagnosing myocardial infarction (MI) in critically ill patients based on screening electrocardiograms (ECGs) and cardiac troponin (cTn) levels.MethodsConsecutive patients admitted to a medical-surgical intensive care unit (ICU) underwent systematic screening with 12-lead ECGs and cTn measurements throughout their ICU stay. Independently, 4 raters interpreted the ECGs assessing for changes indicative of ischemia and then classified each patient as to whether they met diagnostic criteria for MI based on the screening cTn measurements and ECG results. A priori, 2 raters were designated the primary adjudicators, and their consensus was used as the reference for the agreement statistics. Agreement on MI diagnosis was calculated for the 4 raters and expressed as raw agreement, κ (chance-corrected agreement) and ? (chance-independent agreement, calculated using pairs).ResultsAmong 103 enrolled patients, 37 (35.9%) had MI according to the primary adjudicators. The raw agreement for diagnosing MI was 79% (substantial), κ was 0.24 (fair), and ? ranged from 0.12 to 0.73 (slight to substantial).ConclusionsDiagnosing MI in the ICU remains a challenge due to variable agreement in 12-lead ECG interpretation. Such variation in practice may contribute to underrecognition of MI during critical illness. |
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| Keywords: | Troponin Critical illness Intensive care unit Electrocardiography Decision making |
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