Interpretation of exercise stress test recordings: Concordance between nurse practitioner and cardiologist
Interpretation of exercise stress test recordings: Concordance between nurse practitioner and cardiologist
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DOI：
10.1016/j.hrtlng.2007.05.009
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发表时间：
2008-03-01
期刊：
影响因子：
2.8
通讯作者：
Archer, Stephen
中科院分区：
文献类型：
--
作者：
Maier, Evelyn;Jensen, Louise;Archer, Stephen
目的：心脏病学执业护士（NPs）进行运动应激试验（ESTs）诊断心脏病。心脏科医师尚未评估NPs的诊断一致性。假设NP在确定st段压低、检测心律失常和做出诊断评估方面与心脏病专家一样可靠。方法：为一名NP和两名心脏病专家（C1和C2）提供了100次连续的匿名est，包括3次10秒，12导联的基线，运动高峰和恢复追踪。解释是基于基线心律、基线和最大运动ST水平、心律失常和整体诊断（阳性、阴性或不确定是否为缺血）。评分者使用统一的标准来解释EST，并且对先前的EST解释和计算机st段分析不知情。结果：通过Kappa系数测量，NP与心脏病专家之间的一致性与心脏病专家之间的一致性相似（心律：NP vs. C1 = 0.92, NP vs. C2 = 0.84, C1 vs. C2 = 0.84；心律失常：NP vs. C1 = 0.77, NP vs. C2 = 0.73, C1 vs. C2 = 0.75； EST诊断：NP vs. C1 = 0.75, NP vs. C2 = 0.73, C1 vs. C2 = 0.75）。Pearson相关性显示基线ST水平（NP vs. C1 = 0.86, NP vs. C2 = 0.86, C1 vs. C2 = 0.90）和峰值运动ST水平（NP vs. C1 = 0.58, NP vs. C2 = 0.48, C1 vs. C2 = 0.67）具有一致性。结论：评分者与计算机生成的算法在EST解释的所有参数上的一致性为中至高。本研究为NPs解释ESTs提供了支持。
AIM: Cardiology nurse practitioners (NPs) conduct exercise stress tests (ESTs) for diagnosis of cardiac disease. The diagnostic concordance of NPs to cardiologists has not been assessed. The hypothesis was that an NP is as reliable as a cardiologist in determining ST-segment depression, detecting arrhythmias, and making a diagnostic assessment.METHODS: An NP and two cardiologists (C1 and C2) were provided with 100 consecutive, anonymized ESTs, consisting of three 10-second, 12-lead tracings obtained at baseline, peak-exercise, and recovery. Interpretation was based on baseline rhythm, baseline and maximal exercise ST levels, arrhythmias, and global diagnosis (positive, negative, or inconclusive for ischemia). Raters used uniform criteria to interpret ESTs and were blinded to prior EST interpretation and computerized ST-segment analysis.RESULTS: There was similar concordance between the NP and cardiologists as between the cardiologists, measured by Kappa coefficients (rhythm: NP vs. C1 = .92, NP vs. C2 = .84, C1 vs. C2 = .84; arrhythmias: NP vs. C1 = .77, NP vs. C2 = .73, C1 vs. C2 = .75; EST diagnosis: NP vs. C1 = .75, NP vs. C2 = .73, C1 vs. C2 = .75). Pearson correlations demonstrated concordance for baseline ST levels (NP vs. C1 = .86, NP vs. C2 = .86, C1 vs. C2 = .90) and peak exercise ST levels (NP vs. C1 = .58, NP vs. C2 = .48, C1 vs. C2 = .67).CONCLUSIONS: Concordance among raters, and with the computer-generated algorithm, was moderate to high for all parameters of EST interpretation. This study lends support to NPs interpreting ESTs.