Validation of cardiologists’ decisions to initiate reperfusion therapy for acute myocardial infarction with electrocardiograms viewed on liquid crystal displays of cellular telephones.pdfVIP

Validation of cardiologists’ decisions to initiate reperfusion therapy for acute myocardial infarction with electrocardiograms viewed on liquid crystal displays of cellular telephones Paul N. Leibrandt, BA,a Samuel J. Bell, BEnvd,a Michael R. Savona, BA,a Karlton S. Pettis, MD,b Ronald H. Selvester, MD,c Charles Maynard, PhD,d Robert Warner, MD,a and Galen S. Wagner, MDa Durham, NC; Houston, Tex; Long Beach, Calif; and Seattle, Wash Background The transmission of 12-lead electrocardiograms from remote locations to hand-held computers of cardi- ologists is now possible with the development of wireless technology and computer software. This investigation determined whether the cardiologist’s decisions regarding reperfusion therapy for patients with symptoms suggestive of an acute myocardial infarction are the same when given electrocardiograms displayed on a cellular telephone as on a standard paper recording. Methods Cardiologists were given 20 electrocardiograms of patients with acute chest pain suggestive of acute myocardial infarction to test the diagnostic reliability of the Nokia 9000i cellular telephone liquid crystal display (LCD) screen. The cardiologists made their decision to initiate or not initiate reperfusion therapy for the patients after viewing their electrocardiograms displayed on both 5-mm and 1-mm formatted grids and twice on traditional printout electrocardiograms. The control level of intraobserver agreement between the responses from the 2 sets of paper display electrocardiograms was compared with the experimental level of intraobserver agreement between the 1-mm LCD electrocardiograms and both sets of paper display electrocardiograms to determine whether the viewing medium affected the cardiologist’s decisions. The 1-mm and 5-mm LCD screen electrocardiograms were compared to determine if the grid size affected the cardiologist’s decisions. Results Ninety-three percent of the 2 sets of paper-guided decisions were in agreement. When comparing the