The development and validation of an early warning system to prevent the acquisition of 12-lead resting ECGs with interchanged electrode positions.
BACKGROUND
A fraction of routine resting ECG's are taken with electrode positions interchanged, leading to possible clinical misinterpretation.


OBJECTIVE
Develop and test a method to detect and prevent electrode reversals at the electrocardiograph before the ECG is acquired.


METHOD
The algorithm is based on QRS axis and P amplitudes for limb electrode reversals, and P-Q-RS amplitude distances to detect chest electrode reversals. The evaluation method involved a large (>18,000) hospital database for which serial ECG's were available and was based on simulated juxtapositions.


RESULTS
The 7 most common lead reversals could be detected with a specificity of 99.8% per type and an average sensitivity of 90%, excluding LA-LL reversal (22% sensitivity).


DISCUSSION
Results are similar to retrospective studies that used smaller, more homogeneous datasets.


CONCLUSION
The early warning system reduces the ECG's recorded with reversal by 80%, at the price of a modest false alert rate of 1.4%.
['de Bie|Johan|J|', 'Mortara|David W|DW|', 'Clark|Todd F|TF|']
D000465:Algorithms D001145:Arrhythmias, Cardiac D056902:Clinical Alarms D003199:Computer Systems D003936:Diagnosis, Computer-Assisted D003951:Diagnostic Errors D004562:Electrocardiography D004566:Electrodes D005260:Female D006801:Humans D008297:Male D010363:Pattern Recognition, Automated D015203:Reproducibility of Results D012680:Sensitivity and Specificity
ECG Electrode reversal Automatic detection Electrocardiogram Electrode interchange Electrode misplacement