Factors associated with physician modifications to automated ECG interpretations

Accurate diagnoses contribute to the improvement of clinical workflows and the enhancement of patient care. Commercially available automated electrocardiogram (ECG) interpretation systems require manual review by physicians despite their widespread use. This study investigates the frequency and characteristics of the modifications from automated ECG reports in routine clinical practice.

We retrospectively analysed 159 630 ECGs from 2011 to 2023 and compared automated preliminary ECG reports generated by the GE Marquette™ 12SL ECG analysis programme with finalized reports by physicians. A modification was defined as any textual difference between the initial and final reports. Our analysis revealed that 31.3% of all ECG reports underwent some forms of modification by physicians. We analysed the frequency of 69 pre-defined ECG-related terms before and after physician review, categorizing modifications as unchanged, deleted, or newly added. Modifications were more frequent for ECGs performed during off-hours, in patients with higher ventricular rates and longer QRS durations. At the term-level, diagnoses such as ‘prolonged QT interval’ (newly added from 5.6% of original reports) and ‘electronic ventricular pacemaker’ (newly added from 3.6% of original reports) were frequently added by physicians, while diagnoses like ‘inferior infarct’ and ‘anterior infarct’ were frequently deleted from automated ECG reports (32.0% and 44.6% automated reports with these terms required removals).

This large-scale real-world study demonstrated the high frequency of physicians’ modification in automated ECG interpretation. The identified patterns of modifications highlight the limitations of current rule-based systems in handling complex cases and nuanced ECG findings.