Clinician Underappreciation of Interatrial Block in a General Hospital Population
Bibliographic record
Abstract
INTRODUCTION: Interatrial block (IAB; P wave > or =110 ms), a conduction delay between the right and left atria (LA), is highly prevalent and strongly associated with atrial tachyarrhythmias, LA electromechanical dysfunction as well as a risk of embolism. Nonetheless, clinicians' underappreciation of its existence and sequelae remains. We appraised this issue in a general hospital population. METHODS: From the database of 730 12-lead electrocardiograms (ECGs) of patients aged 17-98 years (mean age 67.80 years; female patients 53.56%) in a tertiary care teaching general hospital, we recorded the computer-generated diagnostic readings of the ECGs and also the official cardiologist and hospitalist ECG interpretations and documentations. For increased sensitivity and specificity, and because the mode P wave duration in IAB is 120 ms, P waves > or =120 ms in any lead were used to diagnose IAB. RESULTS: Six hundred and fifty-three ECGs (89.45%) showed sinus rhythm, and of those, IAB was documented on 309 ECGs (47.32%). LA enlargement was cited 29 times (3.97%), while possible LA enlargement and biatrial enlargement were cited 17 (2.32%) and 6 times (0.82%), respectively. One cardiologist's ECG interpretation documented IAB (0.32%), but none of the other medical staff diagnosed IAB or abnormal P wave duration. CONCLUSION: This study demonstrates to extremes how IAB went undiagnosed in a general hospital population. Until more awareness of IAB is cultivated, such ignorance of the existence and sequelae of IAB could continue. Configuring ECG software to include P wave durations in computer-generated ECG readings could be useful in aiding diagnosis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".