Annals of Emergency Medicine
Volume 28, Issue 5 , Pages 515-519 , November 1996

Interrater Agreement in the Measurement of QRS Interval in Tricyclic Antidepressant Overdose: Implications for Monitoring and Research

Received 15 January 1996 ,Accepted 5 July 1996.

References 

  1. Ellenhorn MJ, Barceloux DG. Medical Toxicology: Diagnosis and Treatment of Human Poisoning. New York: Elsevier; 1988;
  2. Poisindex Editorial Board . Tricyclic antidepressants (management/treatment protocol). In:  Rumack BH,  Hess AJ,  Gelmen CR editor. Poisindex System. Englewood, Colorado: Micromedex; 1995;
  3. Weisman RS, Howland MA, Hoffman RS, et al.  Cyclic antidepressants. In: ed 5.  Goldfrank LR editors. Goldfrank's Toxicologic Emergencies. Norwalk, Connecticut: Appleton & Lange; 1994;
  4. Boehnert MT, Lovejoy FH. Value of the QRS duration versus the serum drug level in predicting seizures and ventricular arrhythmias after an acute overdose of tricyclic antidepressants. N Engl J Med. 1985;313:474–479
  5. Thorstrand C. Clinical features in poisonings by tricyclic antidepressants with special reference to the ECG. Acta Med Scand. 1976;199:337–344
  6. Liebelt EL, Francis PD, Woolf AD. ECG lead aVR versus QRS interval in predicting seizures and arrhythmias in acute tricyclic antidepressant toxicity. Ann Emerg Med. 1995;26:195–201
  7. Hulten BA, Heath A. Clinical aspects of tricyclic antidepressant poisoning. Acta Med Scand. 1983;213:275–278
  8. Foulke GE, Albertson TE, Walby WF. Tricyclic antidepressant overdose: Emergency department findings as predictors of clinical course. Am J Emerg Med. 1986;4:496–500
  9. Callaham M, Kassell D. Epidemiology of fatal tricyclic antidepressant ingestion: Implications for management. Ann Emerg Med. 1985;14:29–37
  10. Niemann JT, Bessen HA, Rothstein RJ, et al.  Electrocardiographic criteria for tricyclic antidepressant cardiotoxicity. Am J Cardiol. 1986;57:1154–1159
  11. Wolfe TR, Caravati EM, Rollins DE. Terminal 40-ms frontal plane QRS axis as a marker for tricyclic antidepressant overdose. Ann Emerg Med. 1989;18:348–351
  12. Foulke GE, Albertson TE. QRS interval in tricyclic antidepressant overdosage: Inaccuracy as a toxicity indicator in emergency settings. Ann Emerg Med. 1987;16:39–42
  13. van de Loo A, Arendts W, Hohnloser SH. Variability of QT dispersion measurements in the surface electrocardiogram in patients with acute myocardial infarction and in normal subjects. Am J Cardiol. 1994;74:1113–1118
  14. Willems JL, Arnaud P, Van-Bemmel JH, et al.  Assessment of the performance of electrocardiographic computer programs with the use of a reference database. Circulation. 1985;71:523–534
  15. Pirallo RG, Swor RA, Maio RF. Inter-rater agreement of paramedic rhythm labeling. Ann Emerg Med. 1993;22:1684–1687
  16. Woolley D, Henck M, Luck J. Comparison of electrocardiogram interpretations by family physicians, a computer, and a cardiology service. J Fam Pract. 1992;34:428–432
  17. In:  MacFarlane PW,  Lawrie TDV editor. Comprehensive Electrocardiography: Theory and Practice in Health and Disease. New York: Pergamon Press; 1989;
  18. Buckley NA, Dawson AH, Whyte IM, et al.  Greater toxicity of dothiepin in overdose than of other tricyclic antidepressants. Lancet. 1994;343:159–162
  19. Donner A, Wells G. A comparison of confidence interval methods for the intraclass correlation coefficient. Biometrics. 1986;42:401–412
  20. Cohen J. Weighted kappa: Nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull. 1968;70:213–220
  21. Cohen J. A coefficient of agreement for nominal scales. Educational and Psychological Measurement. 1960;20:37–46
  22. Hanley JA, Lippman-Hand A. If nothing goes wrong is everything alright?. JAMA. 1983;259:1743–1745
  23. Wedin GP, Oderda G, Klein-Schwartz W, et al.  Relative toxicity of cyclic antidepressants. Ann Emerg Med. 1986;14:797–804
  24. Riou B, Barriot P, Rimailho A, et al.  Treatment of severe chloroquine poisoning. N Engl J Med. 1988;318:1–6

 From the Discipline of Clinical Pharmacology, University of Newcastle*; and the Department of Clinical Toxicology and Pharmacology, newcastle Mater Misericordiae Hospital, Newcastle Australia

☆☆ Address for reprints: Nicholas A Buckley, BMed, Mater Misericordiae Hospital, Newcastle, NSW 2298, Australia

 Reprint no. 47/1/77014

PII: S0196-0644(96)70115-4

Annals of Emergency Medicine
Volume 28, Issue 5 , Pages 515-519 , November 1996