Availability and Accuracy of EMS Information about Chronic Health and Medications in Cardiac Arrest

Abstract

IntroductionField information available to emergency medical services (EMS) about a patient’s chronic health conditions or medication therapies could help direct patient care or be used to investigate outcome disparities. However, little is known about the field availability or accuracy of information of chronic health conditions or chronic medication treatments in emergent circumstances, especially when the patient cannot serve as an information resource. We evaluated the prehospital availability and accuracy of specific chronic health conditions and medication treatments among out-of-hospital cardiac arrest (OHCA) patients.MethodsThe investigation was a retrospective cohort study of adult persons suffering ventricular fibrillation OHCA treated by EMS in a large metropolitan county from January 1, 2007, to December 31, 2013. The study was designed to determine the availability and accuracy of EMS ascertainment of selected chronic health conditions and medication treatments. We evaluated chronic health conditions of “any heart disease,” congestive heart failure (CHF), and diabetes and medication treatments of beta blockers and loop diuretics using two distinct sources: 1) EMS report, and 2) hospital record specific to the OHCA event. Because hospital information was considered the gold standard, we restricted the primary analysis to those who were admitted to hospital.ResultsOf the 1,496 initially eligible patients, 387 could not be resuscitated and were pronounced dead in the field, one patient was left alive at scene due to Physician’s Orders for Life-sustaining Treatment (POLST) orders, 125 expired in the emergency department (n=125), and 983 were admitted to hospital. A total of 832 of 1,496 (55.6%) had both sources of data for comparison and comprised the primary analytic group. Using the hospital record as the gold standard, EMS ascertainment had a sensitivity of 0.79 (304/384) and a specificity of 0.88 (218/248) for any prior heart disease; sensitivity 0.45 (47/105) and specificity 0.87 (477/516) for CHF; sensitivity 0.71 (143/201) and specificity 0.98 (416/424) for diabetes; sensitivity 0.70 (118/169) and specificity 0.94 (273/290) for beta blockers; sensitivity 0.70 (62/89) and specificity 0.97 (358/370) for loop diuretics.ConclusionIn this cohort of OHCA, information about selected chronic health conditions and medication treatments based on EMS ascertainment was available for many patients, generally revealing moderate sensitivity and greater specificity.

Clinical Characteristics of Patients With Coronavirus Disease 2019 (COVID-19) Receiving Emergency Medical Services in King County, Washington

“…Nonetheless, EMS ascertainment of comorbidity appears to be a meaningful strategy to assess health status. 17 , 18 The study evaluated EMS involvement with confirmed COVID-19 cases. There may be EMS encounters in which a patient had COVID-19 but was not tested.…”

“…For example, the prevalence of chronic health conditions documented by EMS is likely an underestimate, and the comorbidities overall are likely even more prevalent. Nonetheless, EMS ascertainment of comorbidity appears to be a meaningful strategy to assess health status . The study evaluated EMS involvement with confirmed COVID-19 cases.…”

The association of chronic health status and survival following ventricular fibrillation cardiac arrest: Investigation of a primary myocardial mechanism

“…Moreover the accuracy of this methodology has been validated when compared with hospital-sourced information. 19 The current study evaluates cumulative comorbidity as measured by the Charlson Index and does not investigate a specific comorbidity, its influence on outcome, or whether this relationship may be mediated by primary cardiac mechanism as measured by the AMSA waveform.…”

“…Information about pre-existing, clinically-recognized chronic health conditions was collected from the EMS reports 19 . Information from EMS records is available for all treated patients and has a fair to good kappa with hospital-based information.…”

How Users' Gaze Behavior Is Related to Their Quality Evaluation of a Health Website Based on HONcode Principles?

“…Focusing on the content and design of health websites, some quality principles have been applied in a large number of studies. For example, researchers attempted to evaluate the content of health information from the principle such as accuracy (Buhi et al, 2010;Foster,Florea, Fahrenbruch, Blackwood, & Rea, 2017), completeness (Dutta-Bergman, 2004;Alwhaibi et al, 2019), currency (Williams, 2003), credibility (Avery, 2010;Ma & Atkin, 2017), and readability (Chi, Jabbour, & Aaronson, 2017;Lam, Roter, & Cohen, 2013). Website design was usually evaluated by principles of accessibility (Rezniczek et al, 2015), esthetics (Weymann, Härter, & Dirmaier, 2014), and interactivity (Klila et al, 2013).…”