Telemedicine used for remote prehospital diagnosing in patients suspected of acute myocardial infarction

Terkelsen, Christian Juhl; Nørgaard, Bjarne Linde; Lassen, Jens Flensted; Gerdes, Jens Christian; Ankersen, Jens Peter; Rømer, Frode K.; Nielsen, Torsten T.; Andersen, Henning

doi:10.1046/j.1365-2796.2002.01051.x

Cited by 97 publications

(66 citation statements)

References 20 publications

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“…Tools to aid in ECG interpretation are known to be effective in improving evaluation and potentially reducing errors [48]. Facilities without cardiologists may consider access to specialists through telemedicine links for help with diagnosis and treatment [49]. In addition, efforts to reduce the number of patients leaving emergency departments against medical advice when presenting with cardiac symptoms may help improve diagnosis of AMI.…”

Section: Discussionmentioning

confidence: 99%

Missed diagnoses of acute myocardial infarction in the emergency department: variation by patient and facility characteristics

et al. 2014

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Background: An estimated 1.2 million people in the US have an acute myocardial infarction (AMI) each year. An estimated 7% of AMI hospitalizations result in death. Most patients experiencing acute coronary symptoms, such as unstable angina, visit an emergency department (ED). Some patients hospitalized with AMI after a treatand-release ED visit likely represent missed opportunities for correct diagnosis and treatment. The purpose of the present study is to estimate the frequency of missed AMI or its precursors in the ED by examining use of EDs prior to hospitalization for AMI. Methods: We estimated the rate of probable missed diagnoses in EDs in the week before hospitalization for AMI and examined associated factors. We used Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases for 2007 to evaluate missed diagnoses in 111,973 admitted patients aged 18 years and older. Results: We identified missed diagnoses in the ED for 993 of 112,000 patients (0.9% of all AMI admissions). These patients had visited an ED with chest pain or cardiac conditions, were released, and were subsequently admitted for AMI within 7 days. Higher odds of having missed diagnoses were associated with being younger and of Black

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Section: Discussionmentioning

confidence: 99%

Missed diagnoses of acute myocardial infarction in the emergency department: variation by patient and facility characteristics

et al. 2014

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“…Terkelsen et al 18 e Sillesen et al 19 avaliaram o tempo economizado para iniciar uma intervenção coronária percutânea quando utilizado o foto-ECG, bem como o impacto na saúde do paciente, também encontrando resultados otimistas. Novamente, os estudos se focaram no tempo despendido e não abordaram a concordância do foto-ECG com o ECG de origem.…”

Section: Discussionunclassified

Avaliação do foto-eletrocardiograma como ferramenta de segunda opinião formativa

Canabarro

Schwalbert

Cardoso

et al. 2014

Sci Med

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RESUMOObjetivos: Avaliar o foto-eletrocardiograma (foto-ECG), como uma ferramenta de segunda opinião formativa a distância. Métodos: Cinquenta eletrocardiogramas (ECGs) em papel milimetrado foram fotografados duas vezes, a primeira utilizando-se uma câmera digital Canon, na resolução 0,3 megapixel, e a segunda com um celular Nokia com câmera acoplada, na resolução 2,0 megapixels, gerando 100 foto-ECGs. Por meio de estudos-piloto, definiu-se o método de aquisição das imagens. Os 100 foto-ECGs foram randomizados, criptografados e enviados a um cardiologista remoto por e-mail; enquanto os 50 ECGs em papel milimetrado lhe foram entregues pessoalmente, sem randomização. Sexo e idade foram as únicas informações dos pacientes disponibilizadas ao especialista. Resultados: A análise dos dados demonstrou divergência em 14 dos 50 laudos (28%) na comparação dos ECGs originais com os foto-ECGs adquiridos pela câmera Canon e de 13 dos 50 laudos (26%) entre os laudos dos ECGs originais e dos foto-ECGs capturados pelo celular Nokia. Houve concordância considerável (Kappa=0,356) entre as interpretações de foto-ECGs e ECGs em papel, tanto para o celular Nokia quanto para a câmera Canon. Conclusões: A concordância entre o foto-ECG e os traçados originais demonstrou que o método descrito nesse estudo tem potencial de ser utilizado como uma ferramenta de auxílio à prática clínica, desde que a obtenção dos foto-ECGs seja adaptada de forma a melhorar as imagens dos exames. Apenas com concordância boa a ótima em relação aos ECGs originais, o foto-ECG possibilitará a segunda opinião formativa a distância, conferindo melhores opções diagnósticas e terapêuticas. DESCRITORES: TELEMEDICINA; TELEFONE CELULAR; TÉCNICAS DE DIAGNÓSTICO CARDIOVASCULAR; ELETROCARDIOGRAFIA.ABSTRACT Aims: This study aimed to evaluate the photo-electrocardiogram (photo-ECG), as an alternative tool to enable remote formative second opinion in cardiology. Methods: Fifty paper electrocardiograms (ECGs) were photographed two times, the first using a Canon digital camera, 0.3 megapixel resolution, and the second using a Nokia mobile phone integrated camera, 2.0 megapixel resolution, resulting in 100 Photo-ECGs. A pilot study was responsible for determining the acquisition method. The 100 Photo-ECGs were randomized, encrypted and sent by e-mail to a remote cardiologist, while the 50 paper ECGs were delivered to him in person, without randomization. Gender and age were the only patient information made available to the specialist. Results: Data analysis demonstrated a disagreement in 14 of 50 interpretations (28%) when comparing paper ECGs to the Canon camera photo-ECGs and in 13 of 50 interpretations (26%) when comparing paper ECGs to the Nokia camera photo-ECGs. The Kappa test revealed a fair agreement (Kappa=0.356) between interpretations when comparing the original ECGs to their respective photo-ECGs for both camera devices. Conclusion:The concordance between photo-ECGs and original tracings demonstrated that the method described herein has the potential for use as a t...

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“…From 1999, when the DANAMI-2 trial was still ongoing, prehospital diagnosis was gradually introduced in Denmark. 4 From 2006, all EMS vehicles had equipment for ECG transmission, and when combining prehospital diagnosis with field triage directly to PPCI centers, a Ͼ1-hour reduction in overall delay from the EMS call to PPCI (system delay) was observed. 6,19 Accordingly, triage of patients with STEMI for PPCI has improved considerably after the DANAMI-2 trial and the …”

Section: Discussionmentioning

confidence: 99%

“…1 Patients must meet the following criteria to be eligible for PPCI: symptom duration of Յ12 hours and ST-segment elevation Ն0.1 mV in at least 2 contiguous leads (Ն0.2 mV in V 1 -V 3 ) or presumed new-onset left bundle branch block. In 1999, prehospital diagnosis using telemedicine was introduced, 4 and in 2000, the National Board of Health decided that before 2006, all EMS vehicles should have equipment for 12-lead ECG acquisition and wireless transmission to a physician at the hospital. Field triage of patients directly to PPCI centers was introduced in 2003.…”

Section: Patients and Proceduresmentioning

confidence: 99%

Primary Percutaneous Coronary Intervention as a National Reperfusion Strategy in Patients With ST-Segment Elevation Myocardial Infarction

Terkelsen

Jensen

Tilsted

et al. 2011

Circ: Cardiovascular Interventions

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Background-In Denmark, primary percutaneous coronary intervention (PPCI) was chosen as a national reperfusion strategy for patients with ST-segment elevation myocardial infarction in 2003. This study describes the temporal implementation of PPCI in Western Denmark, the gradual introduction of field triage for PPCI (patients rerouted from the scene of the event directly to the invasive center), and the associated outcome. Methods and Results-The study population comprised 9514 patients treated with PPCI from 1999 to 2009 with symptom duration Յ12 hours and either a delay from the emergency medical service (EMS) call to PPCI (healthcare system delay) of Յ6 hours or as self-presenters. The median follow-up time was 3.7 years. The number of patients treated with PPCI increased from 190 in 1999 to 1212 in 2009. Among patients transported by the EMS from the scene of the event, the proportion who were field triaged directly to a PCI center increased from 33% (34/103) to 72% (616/851, PϽ0.001).Patients who were field triaged had lower long-term mortality, with adjusted hazard ratios (95% CI) of 1.26 (1.12-1.43) among patients transported by the EMS to a local hospital and then transferred, 1.28 (1.10 -1.49) among patients self-presenting at a local hospital and then transferred, and 1.37 (1.18 -1.58) among patients self-presenting at a PCI center. Conclusions-A reperfusion strategy with PPCI only for patients with ST-segment elevation myocardial infarction was successfully implemented in Western Denmark, and the majority of patients transported by the EMS are now triaged directly to the PPCI centers. This strategy is associated with lower mortality. (Circ Cardiovasc Interv. 2011;4:570-576.)

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Telemedicine used for remote prehospital diagnosing in patients suspected of acute myocardial infarction

Abstract: Abstract. Terkelsen CJ,

Cited by 97 publications

References 20 publications

Missed diagnoses of acute myocardial infarction in the emergency department: variation by patient and facility characteristics

Missed diagnoses of acute myocardial infarction in the emergency department: variation by patient and facility characteristics

Avaliação do foto-eletrocardiograma como ferramenta de segunda opinião formativa

Primary Percutaneous Coronary Intervention as a National Reperfusion Strategy in Patients With ST-Segment Elevation Myocardial Infarction

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