tag:blogger.com,1999:blog-549949223388475481.post3254650161273085822..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: How unreliable are computer algorithms in the Diagnosis of STEMI?Unknownnoreply@blogger.comBlogger6125tag:blogger.com,1999:blog-549949223388475481.post-12419271210461265642017-04-29T09:18:07.577-05:002017-04-29T09:18:07.577-05:00Agreed
Agreed<br />vijay saxenanoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-70286212156279451832017-04-29T09:17:09.618-05:002017-04-29T09:17:09.618-05:00Agreed
Agreed<br />vijay saxenanoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-37796270522636030182017-04-29T09:15:02.424-05:002017-04-29T09:15:02.424-05:00Agreed,Steve.
Vijay SaxenaAgreed,Steve.<br />Vijay Saxenavijay saxenanoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-76412118576433492992017-03-11T08:28:30.786-06:002017-03-11T08:28:30.786-06:00You are absolutely right. However, papers like th...You are absolutely right. However, papers like this get misinterpreted, and the misinterpretation gets propagated from person to person. 2 years from now, the paper will be summarized as: "if the computer says normal, the doctor doesn't need to read it." We must guard against that.Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-40982810326543554812017-03-10T17:52:52.692-06:002017-03-10T17:52:52.692-06:00Having been a student of (and author on) computeri...Having been a student of (and author on) computerized ECG interpretations for the past 30 years — I long ago learned that the first priority for providers to master is appreciation of what the computer is good at, and what it is not good at. Computerized ECG interpretations have never been shown to have high enough sensitivity for assessing subtle infarctions to be used as a “stand-alone” tool (http://ecg-interpretation.blogspot.com/2016/05/ecg-blog-126-computerized-ecg.html ). This superb case by Dr. Smith illustrates this concept to perfection — as not only are T waves in V2-thru-V4 disproportionately tall and peaked — but there is ST segment straightening that is clearly abnormal in lead V5 and V6 (as well as having inappropriately peaked T waves in those leads) — plus subtle-but-real ST-T wave abnormalities in each of the inferior leads — that in a patient brought by ambulance for chest pain says, “I am an acute or very recent STEMI until you prove otherwise!” Anyone who has studied computerized ECG interpretations will not be surprised by the fact that these clearly abnormal ECG findings were totally missed by the computer report. Except for “true expert interpreters” (ie, clinicians who have read many, many thousands of acute and non-acute tracings over time — NO provider (in my opinion) should ever look at the computerized report BEFORE they have completed their own unbiased ECG interpretation. Following this simple advice would greatly reduce the chance of overlooking the subtle-but-real series of abnormalities that are clearly present on this initial ECG. THANKS so much to Dr. Smith for posting this case!ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-3947708607073643372017-03-10T11:30:48.739-06:002017-03-10T11:30:48.739-06:00I don't think Salon's post regarding this ...I don't think Salon's post regarding this paper implied computers are good surrogates of doctors. As I understood, it advocated for considering the significant disruptions caused by EKGs handed to attendings, without a perceivable change in patient outcomes. I would also add the effects of such disruptions on other patients care as well as false reassurance of No STEMI signature by cursory look to other staff (junior practitioners, RNs). I think it is much more likely that I would pick up the hyperacute To waves on this EKG if I was not supposed to read it in 10 seconds.Danielhttps://www.blogger.com/profile/01990689460194318668noreply@blogger.com