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- W2022607737 abstract "The development of a soundly based, widely acceptable uniform terminology for electrocardiographic interpretation is difficult. Physicians frequently disagree about the classification of features in an individual record, and similar disagreements occur in reports generated by different computer programs.‘-1s Some disagreement results from technical error, but the remainder arises from differences in measurement technique, terminology and criteria. Standard rules for measurement, classification and description of electrocardiographic features appear desirable to improve patient care by improving the consistency and quality of the report as well as communication between the interpreter and the user. The standards should be flexible enough to provide for continuing incorporation of improvements in electrocardiographic diagnoses, for classification of features from different populations and for different categories of users. Standards for medical procedures are more readily accepted if they are logical, easily understandable and auth0ritative.l’ However, significant variability in electrocardiographic classification persists even when physicians agree to use identical criteria.44 Imprecise identification of the onset and offset of electrocardiographic deflections is one source of variability in classification procedure, but this type of error can be minimized by proper selection of criteria.lzJs There is no comprehensive list of definitions and criteria designed for the use of electrocardiographic interpreters. The New York Heart Association monograph on nomenclature14 focuses on comprehensive cardiac diagnosis rather than the electrocardiographic report. One of the best known digital coding systems, the Minnesota Code, has precisely defined criteria for classifying electrocardiographic features but is more useful in large scale clinical studies than in the interpretation of routine clinical reports.15J6 Types of interpretive statements: Selecting criteria for each electrocardiographic interpretive statement may be more difficult than selecting terminology. Statements can be divided arbitrarily into three types: (1) Type A refers to an anatomic lesion or pathophysiologic state that can be verified by nonelectrocardiographic evidence; this includes hypertrophy, infarction, ischemia, pulmonary disease and drug and metabolic effects. Selection of optimal criteria for type A statements depends on confirmatory nonelectrocardiographic information, which is limited in many instances at present. (2) Type B refers to an anatomic or functional disturbance that is detectable by the electrocardiogram itself (including special intracardiac leads). Criteria for these statements are based on characteristic features, and pertain mostly to arrhythmias and conduction disturbances. (3) Type C refers to electrocardiographic features that do not fit into type A and B categories. These include electrical axis, nonspecific T wave abnormalities, “premature repolarization,” and unusual voltage. It appears reasonable to define interim standards for types B and C statements at this time, with the understanding that they may be modified by additional information. Selection of criteria: For any type of electrocardiographic statement criteria should be selected with regard to sources of uncertainty that determine the accuracy of the statement; this principle is common to all medical diagnoses. 11~17-21 With respect to electrocardiographic diagnosis, numerous sources of uncertainty include physiologic variations from complex to complex or from day to day, variations in recording equipment or technique, recognition and measurement of the recorded wave forms, morphologic and etiologic classification of electrocardiographic features, and inadequate communication between the interpreter and user of the report.2,22*23 Criteria for classification into different categories should not depend on a difference between measurements resulting from chance variations.zJ4 Borderline regions should be defined on the basis of total precision for both the measurement and the criteria. The definition of pathologic states responsible for the electrocardiographic changes is not necessarily precise. This may complicate establishment of valid criteria. The problem of classifying “microinfarcts” in a correlative study of electrocardiographic criteria is one example of this situation.25 Variations in electrocardiographic measurements associated with age and other constitutional factors make it imperative that all comparisons be made between similar population samples. Collection of data from large samples of healthy and diseased populations" @default.
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- W2022607737 date "1978-01-01" @default.
- W2022607737 modified "2023-10-16" @default.
- W2022607737 title "Task force I: Standardization of terminology and interpretation" @default.
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