Interpretation of immediate exercise treadmill test

Interreader reliability between cardiologist and noncardiologist in a chest pain evaluation unit

James D Kirk, Samuel D Turnipseed, Deborah B. Diercks, Damon London, Ezra A Amsterdam

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Study objective: To determine whether attending physicians in a chest pain evaluation unit (CPEU) can perform and interpret exercise testing with the same accuracy as cardiologists. Methods: Between January 1996 and November 1998, immediate exercise tests were performed and interpreted by internists with additional training in exercise testing who serve as attending physicians in a CPEU at a large university medical center. For quality assurance, all tests were overread by a cardiologist. Test results were compared for each reader, and all tests with discrepant readings were reinterpreted by an independent cardiologist who was blinded to the previous results. Patients' clinical course was monitored for at least 30 days after exercise testing. Results: The study group consisted of 645 patients (347 men, 298 women). Discrepant interpretations were found in 11 (1.7%) patients. The agreement was 98.4% (κ value 0.9618). The majority of discrepancies were insignificant and were based on subtle differences in the definition of a nondiagnostic test or the degree of ST-segment shift. Of the 11 discordant readings, the blinded cardiologist concurred with 5 (45%) of the CPEU interpretations and 4 (36%) of the cardiologist interpretations. In 2 cases, there was disagreement by all 3 interpreters. There was no cardiac morbidity or mortality of any patient with a discrepant reading. Conclusion: Our results suggest that noncardiologists serving as attending physicians in a CPEU can accurately interpret exercise tests and overreading by cardiologists for quality assurance is unnecessary.

Original languageEnglish (US)
Pages (from-to)10-14
Number of pages5
JournalAnnals of Emergency Medicine
Volume36
Issue number1
StatePublished - 2000

Fingerprint

Chest Pain
Exercise Test
Reading
Exercise
Physicians
Cardiologists
Morbidity
Mortality

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

@article{e8e9375e97bc4fe8badfc01eb29649be,
title = "Interpretation of immediate exercise treadmill test: Interreader reliability between cardiologist and noncardiologist in a chest pain evaluation unit",
abstract = "Study objective: To determine whether attending physicians in a chest pain evaluation unit (CPEU) can perform and interpret exercise testing with the same accuracy as cardiologists. Methods: Between January 1996 and November 1998, immediate exercise tests were performed and interpreted by internists with additional training in exercise testing who serve as attending physicians in a CPEU at a large university medical center. For quality assurance, all tests were overread by a cardiologist. Test results were compared for each reader, and all tests with discrepant readings were reinterpreted by an independent cardiologist who was blinded to the previous results. Patients' clinical course was monitored for at least 30 days after exercise testing. Results: The study group consisted of 645 patients (347 men, 298 women). Discrepant interpretations were found in 11 (1.7{\%}) patients. The agreement was 98.4{\%} (κ value 0.9618). The majority of discrepancies were insignificant and were based on subtle differences in the definition of a nondiagnostic test or the degree of ST-segment shift. Of the 11 discordant readings, the blinded cardiologist concurred with 5 (45{\%}) of the CPEU interpretations and 4 (36{\%}) of the cardiologist interpretations. In 2 cases, there was disagreement by all 3 interpreters. There was no cardiac morbidity or mortality of any patient with a discrepant reading. Conclusion: Our results suggest that noncardiologists serving as attending physicians in a CPEU can accurately interpret exercise tests and overreading by cardiologists for quality assurance is unnecessary.",
author = "Kirk, {James D} and Turnipseed, {Samuel D} and Diercks, {Deborah B.} and Damon London and Amsterdam, {Ezra A}",
year = "2000",
language = "English (US)",
volume = "36",
pages = "10--14",
journal = "Annals of Emergency Medicine",
issn = "0196-0644",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Interpretation of immediate exercise treadmill test

T2 - Interreader reliability between cardiologist and noncardiologist in a chest pain evaluation unit

AU - Kirk, James D

AU - Turnipseed, Samuel D

AU - Diercks, Deborah B.

AU - London, Damon

AU - Amsterdam, Ezra A

PY - 2000

Y1 - 2000

N2 - Study objective: To determine whether attending physicians in a chest pain evaluation unit (CPEU) can perform and interpret exercise testing with the same accuracy as cardiologists. Methods: Between January 1996 and November 1998, immediate exercise tests were performed and interpreted by internists with additional training in exercise testing who serve as attending physicians in a CPEU at a large university medical center. For quality assurance, all tests were overread by a cardiologist. Test results were compared for each reader, and all tests with discrepant readings were reinterpreted by an independent cardiologist who was blinded to the previous results. Patients' clinical course was monitored for at least 30 days after exercise testing. Results: The study group consisted of 645 patients (347 men, 298 women). Discrepant interpretations were found in 11 (1.7%) patients. The agreement was 98.4% (κ value 0.9618). The majority of discrepancies were insignificant and were based on subtle differences in the definition of a nondiagnostic test or the degree of ST-segment shift. Of the 11 discordant readings, the blinded cardiologist concurred with 5 (45%) of the CPEU interpretations and 4 (36%) of the cardiologist interpretations. In 2 cases, there was disagreement by all 3 interpreters. There was no cardiac morbidity or mortality of any patient with a discrepant reading. Conclusion: Our results suggest that noncardiologists serving as attending physicians in a CPEU can accurately interpret exercise tests and overreading by cardiologists for quality assurance is unnecessary.

AB - Study objective: To determine whether attending physicians in a chest pain evaluation unit (CPEU) can perform and interpret exercise testing with the same accuracy as cardiologists. Methods: Between January 1996 and November 1998, immediate exercise tests were performed and interpreted by internists with additional training in exercise testing who serve as attending physicians in a CPEU at a large university medical center. For quality assurance, all tests were overread by a cardiologist. Test results were compared for each reader, and all tests with discrepant readings were reinterpreted by an independent cardiologist who was blinded to the previous results. Patients' clinical course was monitored for at least 30 days after exercise testing. Results: The study group consisted of 645 patients (347 men, 298 women). Discrepant interpretations were found in 11 (1.7%) patients. The agreement was 98.4% (κ value 0.9618). The majority of discrepancies were insignificant and were based on subtle differences in the definition of a nondiagnostic test or the degree of ST-segment shift. Of the 11 discordant readings, the blinded cardiologist concurred with 5 (45%) of the CPEU interpretations and 4 (36%) of the cardiologist interpretations. In 2 cases, there was disagreement by all 3 interpreters. There was no cardiac morbidity or mortality of any patient with a discrepant reading. Conclusion: Our results suggest that noncardiologists serving as attending physicians in a CPEU can accurately interpret exercise tests and overreading by cardiologists for quality assurance is unnecessary.

UR - http://www.scopus.com/inward/record.url?scp=0033870228&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033870228&partnerID=8YFLogxK

M3 - Article

VL - 36

SP - 10

EP - 14

JO - Annals of Emergency Medicine

JF - Annals of Emergency Medicine

SN - 0196-0644

IS - 1

ER -