Abstract：
The skill of interpretation of the electrocardiogram (ECG) remains poor despite existing educational initiatives. We sought to evaluate the validity of using a subjective scoring system to assess the accuracy of ECG interpretations submitted by pediatric cardiology fellows, trainees, and faculty to the Pediatric ECG Review (pECGreview), a web-based ECG interpretation training program. We conducted a retrospective, cross-sectional study of responses submitted to pECGreview. ECG interpretations were assessed independently by four individuals with a range of experience. Accuracy was assessed using a 3-point scale: 100% for generally correct interpretations, 50% for over- or underdiagnosis of minor ECG abnormalities, and 0% for over- or underdiagnosis of major ECG abnormalities. Inter-rater agreement was assessed using expanded Bland-Altman plots, Pearson correlation coefficients, and Intraclass Correlation Coefficients (ICC). 1460 ECG interpretations by 192 participants were analyzed. 107 participants interpreted at least five ECGs. The mean accuracy score was 76.6 ± 13.7%. Participants were correct in 66.1 ± 5.1%, had minor over- or underdiagnosis in 21.5 ± 4.6% and major over- or underdiagnosis in 12.3 ± 3.9% of interpretations. Validation of agreement between evaluators demonstrated limits of agreement of 11.3%. Inter-rater agreement exhibited consistent patterns (all correlations ≥ 0.75). Absolute agreement was 0.74 (95% CI 0.69-0.80), and average measures agreement was 0.92 (95% CI 0.89-0.94). Accuracy score analysis of as few as five ECG interpretations submitted to pECGreview yielded good inter-rater reliability for assessing and ranking ECG interpretation skills in pediatric cardiology fellows in training.
摘要：
尽管存在教育计划，但心电图（ECG）的解释技能仍然很差。我们试图评估使用主观评分系统来评估儿科心脏病学研究员提交的ECG解释的准确性的有效性。学员,和教师儿科心电图审查（pECGreview），基于网络的心电图解释培训计划。我们做了一个回顾,提交给pECGreview的答复的横断面研究。ECG解释由具有一定经验的四个人独立评估。使用3点量表评估准确性：对于一般正确的解释，100％50%为轻微心电图异常的过度诊断或诊断不足，主要心电图异常的过度诊断或诊断不足为0%。使用扩大的Bland-Altman地块评估了评估者之间的协议，皮尔逊相关系数，和类内相关系数(ICC)。分析了192名参与者的1460次心电图解释。107名参与者解释了至少五个心电图。平均准确率为76.6±13.7%。参与者的正确率为66.1±5.1％，在21.5±4.6%的解释中有轻微的过度诊断或诊断不足，在12.3±3.9%的解释中有严重的过度诊断或诊断不足。评估者之间的协议验证表明协议限制为11.3%。评分者之间的一致性表现出一致的模式(所有相关性≥0.75)。绝对一致性为0.74(95%CI0.69-0.80)，平均措施协议为0.92（95%CI0.89-0.94）。提交给pECGreview的仅五种ECG解释的准确性评分分析产生了良好的评分者间可靠性，可用于评估和排名儿科心脏病学研究员在培训中的ECG解释技能。
