Estudio de fiabilidad en la interpretación del electrocardiograma por médicos de familia y médicos residentes / Reliability study on the interpretation of electrocardiograms by general practitioners and trainees

Objetivo. Conocer la fiabilidad en la interpretación del electrocardiograma (ECG) por médicos de familia en ejercicio y médicos residentes en periodo de formación, utilizando para ello la comparación con la interpretación realizada por el cardiólogo. Material y métodos. Estudio observacional. Se incluyeron médicos de familia en ejercicio del Área de Salud de Toledo, médicos internos residentes de Medicina Familiar y Comunitaria y los médicos internos residentes de Cardiología de los 3 años iniciales del periodo formativo (R1-R3). Se utilizó un cuestionario con 13 ECG sin datos clínicos del paciente. Los 13 ECG fueron seleccionados y sus diagnósticos consensuados por 2 cardiólogos del Complejo Hospitalario de Toledo. Resultados. El porcentaje de respuestas correctas más alto (82,3%) correspondió al ECG 5 (fibrilación auricular), y el más bajo (26,5%), al ECG 11 (ritmo de la unión). La competencia diagnóstica más alta fue alcanzada por los médicos residentes de Cardiología, los médicos de familia en ejercicio, los tutores de residentes y los médicos con trabajo en el Servicio de Urgencias del hospital. Los valores más altos de odds ratio para una mayor competencia diagnóstica fueron trabajar en el Servicio de Urgencias y ser médico de familia en ejercicio, ambas con resultados casi significativos (p<0,10). Conclusiones. Los médicos de familia y los médicos residentes tienen un grado de fiabilidad medio en la interpretación del ECG con relación al cardiólogo

Objective. To determine the reliability of the interpretation of electrocardiograms (ECG) by general practitioners and those in training by making a comparison with the interpretation made by the cardiologist. Material and methods. An observational study was conducted that included general practitioners working in the Toledo Health Area, physicians during their training in Family and Community Medicine, and cardiologists in their first 3 years of specialist training (R1-R3). A questionnaire was used that included 13 ECGs with no clinical details of the patient. The 13 ECGs were selected and their diagnoses made by consensus by 2 cardiologists from the Toledo Hospital Complex. Results. The highest percentage of correct answers (82.3%) was obtained for ECG 5 (atrial fibrillation), and the lowest (26.5%) for ECG 11 (junctional rhythm). The highest diagnostic skill was achieved by the resident cardiologists, general practitioners, medical tutors, and doctors who had worked in hospital emergency departments. The highest odds ratio for a higher diagnostic skill was to work in an emergency department and be a practising general practitioner, both with almost significant results (P<.10). Conclusions. Family physicians and those in training have a medium level of reliability in the interpretation of an ECG compared to the cardiologist

[Reliability study on the interpretation of electrocardiograms by general practitioners and trainees]. / Estudio de fiabilidad en la interpretación del electrocardiograma por médicos de familia y médicos residentes.

OBJECTIVE: To determine the reliability of the interpretation of electrocardiograms (ECG) by general practitioners and those in training by making a comparison with the interpretation made by the cardiologist. MATERIAL AND METHODS: An observational study was conducted that included general practitioners working in the Toledo Health Area, physicians during their training in Family and Community Medicine, and cardiologists in their first 3 years of specialist training (R1-R3). A questionnaire was used that included 13 ECGs with no clinical details of the patient. The 13 ECGs were selected and their diagnoses made by consensus by 2 cardiologists from the Toledo Hospital Complex. RESULTS: The highest percentage of correct answers (82.3%) was obtained for ECG 5 (atrial fibrillation), and the lowest (26.5%) for ECG 11 (junctional rhythm). The highest diagnostic skill was achieved by the resident cardiologists, general practitioners, medical tutors, and doctors who had worked in hospital emergency departments. The highest odds ratio for a higher diagnostic skill was to work in an emergency department and be a practising general practitioner, both with almost significant results (P<.10). CONCLUSIONS: Family physicians and those in training have a medium level of reliability in the interpretation of an ECG compared to the cardiologist.

Recomendaciones de buena práctica clínica en arritmias / Good clinical practice recommendations in arrhythymias

Las arritmias son, quizá, una de las patologías que más intranquilidad provoca en el médico de atención primaria. Esto es especialmente cierto ante episodios agudos de taquicardia, en las cuales con frecuencia se duda a la hora de decidir qué fármaco utilizar por temor a empeorar el cuadro. Por otro lado, con frecuencia se detectan de forma casual distintos tipos de arritmias asintomáticas en electrocardiogramas rutinarios; las dudas en este caso suelen plantearse respecto a si es necesario tratarlas o no. Saber identificar el tipo de trastorno del ritmo en base al patrón electrocardiográfico es el primer paso indispensable para poder enfrentarnos a estas patologías. En el presente artículo se pretende realizar una revisión de las arritmias más frecuentes, con especial énfasis en su diagnóstico electrocardiográfico, sus causas más frecuentes, su significación pronóstica y su tratamiento (AU)

Arrhythmias are, perhaps, one of the diseases that cause the most concern in the primary care physician. This is especially true when these are acute episodes of tachycardia, in which the physician frequently has doubts about which drug can be used without worsening the clinical picture. On the other hand, different types of asymptomatic arrhythmias are frequently detected on the routine electrocardiograms. In this case, doubt arises regarding whether these should be treated or not. Knowing how to identify the type of rhythm disorder based on the electrocardiographic pattern is the first essential step in order to cope with these conditions. In this article, it has been aimed to make a review on the most frequent arrhythmias, placing special emphasis on their electrocardiographic diagnosis, their most frequent causes, their prognostic significance and treatment (AU)