Person:
Waldo, Stephen W.

Profile Picture

Email Address

AA Acceptance Date

Birth Date

Research Projects

Organizational Units

Job Title

Last Name

Waldo

First Name

Stephen W.

Name

Waldo, Stephen W.

Filters

2013 - 20142

Settings

Author's Publications: search.filters.isAuthorOfPublication.16a6c62a-cb2a-450b-ab35-5b0d72f3bffd

Search Results

Now showing 1 - 2 of 2
  • Thumbnail Image
    Publication
    Physician Accuracy in Interpreting Potential ST‐Segment Elevation Myocardial Infarction Electrocardiograms
    (Blackwell Publishing Ltd, 2013) McCabe, James M.; Armstrong, Ehrin J.; Ku, Ivy; Kulkarni, Ameya; Hoffmayer, Kurt S.; Bhave, Prashant D.; Waldo, Stephen W.; Hsue, Priscilla; Stein, John C.; Marcus, Gregory M.; Kinlay, Scott; Ganz, Peter
    Background: With adoption of telemedicine, physicians are increasingly asked to diagnose ST‐segment elevation myocardial infarctions (STEMIs) based on electrocardiograms (ECGs) with minimal associated clinical information. We sought to determine physicians' diagnostic agreement and accuracy when interpreting potential STEMI ECGs. Methods and Results: A cross‐sectional survey was performed consisting of 36 deidentified ECGs that had previously resulted in putative STEMI diagnoses. Emergency physicians, cardiologists, and interventional cardiologists participated in the survey. For each ECG, physicians were asked, “based on the ECG above, is there a blocked coronary artery present causing a STEMI?” The reference standard for ascertaining the STEMI diagnosis was subsequent emergent coronary arteriography. Responses were analyzed with generalized estimating equations to account for nested and repeated measures. One hundred twenty‐four physicians interpreted a total of 4392 ECGs. Among all physicians, interreader agreement (kappa) for ECG interpretation was 0.33, reflecting poor agreement. The sensitivity to identify “true” STEMIs was 65% (95% CI: 63 to 67) and the specificity was 79% (95% CI: 77 to 81). There was a 6% increase in the odds of accurate ECG interpretation for every 5 years of experience since medical school graduation (OR 1.06, 95% CI: 1.02 to 1.10, P=0.01). After adjusting for experience, there was no significant difference in the odds of accurate interpretation by specialty—Emergency Medicine (reference), General Cardiology (AOR 0.97, 95% CI: 0.79 to 1.2, P=0.80), or Interventional Cardiology physicians (AOR 1.24, 95% CI: 0.93 to 1.7, P=0.15). Conclusions: There is significant physician disagreement in interpreting ECGs with features concerning for STEMI. Such ECGs lack the necessary sensitivity and specificity to act as a suitable “stand‐alone” diagnostic test.
  • Thumbnail Image
    Publication
    Clinical Preventability of 30‐Day Readmission After Percutaneous Coronary Intervention
    (Blackwell Publishing Ltd, 2014) Wasfy, Jason; Strom, Jordan B.; Waldo, Stephen W.; O'Brien, Cashel; Wimmer, Neil J.; Zai, Adrian; Luttrell, Jennifer; Spertus, John A.; Kennedy, Kevin F.; Normand, Sharon‐Lise T.; Mauri, Laura; Yeh, Robert
    Background: Early readmission after PCI is an important contributor to healthcare expenditures and a target for performance measurement. The extent to which 30‐day readmissions after PCI are preventable is unknown yet essential to minimizing their occurrence. Methods and Results: PCI patients readmitted to hospital at which PCI was performed within 30 days of discharge at the Massachusetts General Hospital and Brigham and Women's Hospital were identified, and their medical records were independently reviewed by 2 physicians. Each reviewer used an ordinal scale (0, not; 1, possibly; 2, probably; and 3, definitely preventable) to rate clinical preventability, and a total sum score ≥2 was considered preventable. Characteristics of preventable and unpreventable readmissions were compared, and predictors of clinical preventability were assessed by using multivariate logistic regression. Of 9288 PCIs performed, 9081 (97.8%) patients survived to initial hospital discharge and 1007 (11.1%) were readmitted to the index hospital within 30 days. After excluding repeat readmissions, 893 readmissions were reviewed. Fair agreement between physician reviewers was observed (weighted κ statistic 0.44 [95% CI 0.39 to 0.49]). After aggregation of scores, 380 (42.6%) readmissions were deemed preventable and 513 (57.4%) were deemed not preventable. Common causes of preventable readmissions included staged PCI without new symptoms (14.7%), vascular/bleeding complications of PCI (10.0%), and congestive heart failure (9.7%). Conclusions: Nearly half of 30‐day readmissions after PCI may have been prevented by changes in clinical decision‐making. Focusing on these readmissions may reduce readmission rates.