The availability of prior ECGs improves paramedic accuracy in recognizing ST-segment elevation myocardial infarction

O’Donnell, Daniel; Mancera, Mike; Savory, Eric; Christopher, Shawn; Schaffer, Jason T.; Roumpf, Steve

doi:10.1016/j.jelectrocard.2014.09.003

Cited by 17 publications

(10 citation statements)

References 19 publications

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“…Recording of pre-hospital ECG and notification of PCI center result in a substantial reduction in reperfusion time which in turn leads to survival benefit [13][14][15]. O'Donnell et al [16] reported that the availability of prior ECG recordings improved paramedic accuracy in recognizing ST-elevation pattern and diagnosing STEMI. In the present study it was found that only 38.4% of physician-led ambulances and 60% of paramedic-led ambulances transmitted ECG recording to a PCI center (p < 0.0001).…”

Section: Discussionmentioning

confidence: 99%

Paramedic versus physician-staffed ambulances and prehospital delays in the management of patients with ST-segment elevation myocardial infarction

Borowicz¹,

Nadolny

Bujak

et al. 2021

Cardiol J.

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Background: Time delays to reperfusion therapy in ST-segment elevation myocardial infarction (STEMI) still remain a considerable drawback in many healthcare systems. Emergency medical service (EMS) has a critical role in the early management of STEMI. Under investigation herein, was whether the use of physician-staffed ambulances leads to shorter pre-hospital delays in STEMI patients. Methods: This was an observational and retrospective study, using data from the registry of the Silesian regional EMS system in Katowice, Poland and the Polish Registry on Acute Coronary Syndromes (PL-ACS) for a study period of January 1, 2013 to December 31, 2016. The study population (n = 717) was divided into two groups: group 1 (n = 546 patients)-physician-staffed ambulances and group 2 (n = 171 patients)-paramedic-staffed ambulances. Results: Responses during the day and night shifts were similar. Paramedic-led ambulances more often transmitted 12-lead electrocardiogram (ECG) to the percutaneous coronary intervention centers. All EMS time intervals were similar in both groups. The type of EMS dispatched to patients (physicianstaffed vs. paramedic/nurse-only staffed ambulance) was adjusted for ECG transmission, sex had no impact on in-hospital mortality (odds ratio [OR] 1.41; 95% confidence interval [CI] 0.79-1.95; p = 0.4). However, service time exceeding 42 min was an independent predictor of in-hospital mortality (OR 4.19; 95% CI 1.27-13.89; p = 0.019). In-hospital mortality rate was higher in the two upper quartiles of service time in the entire study population. Conclusions: These findings suggest that both physician-led and paramedic-led ambulances meet the criteria set out by the Polish and European authorities. All EMS time intervals are similar regardless of the type of EMS unit dispatched. A physician being present on board did not have a prognostic impact on outcomes.

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Section: Discussionmentioning

confidence: 99%

Paramedic versus physician-staffed ambulances and prehospital delays in the management of patients with ST-segment elevation myocardial infarction

Borowicz¹,

Nadolny

Bujak

et al. 2021

Cardiol J.

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“…Another strategy for improving computerized STEMI detection would be incorporating prior ECG findings into computerized algorithms since serial ECGs can significantly increase the sensitivity for a STEMI diagnosis [6,16,17]. Prior studies show that serial or continuous ECGs improve the diagnostic accuracy for STEMI since a single static “snap-shot” 12-lead ECG may miss dynamic ischemic changes.…”

Section: Discussionmentioning

confidence: 99%

Electrocardiographic diagnosis of ST segment elevation myocardial infarction: An evaluation of three automated interpretation algorithms

Garvey

Zègre‐Hemsey

Gregg

et al. 2016

Journal of Electrocardiology

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Objective To assess the validity of three different computerized electrocardiogram (ECG) interpretation algorithms in correctly identifying STEMI patients in the prehospital environment who require emergent cardiac intervention. Methods This retrospective study validated three diagnostic algorithms (AG) against the presence of a culprit coronary artery upon cardiac catheterization. Two patient groups were enrolled in this study: those with verified prehospital ST-elevation myocardial infarction (STEMI) activation (cases) and those with a prehospital impression of chest pain due to ACS (controls). Results There were 500 records analyzed resulting in a case group with 151 patients and a control group with 349 patients. Sensitivities differed between AGs (AG1 = 0.69 vs AG2 = 0.68 vs AG3 = 0.62), with statistical differences in sensitivity found when comparing AG1 to AG3 and AG1 to AG2. Specificities also differed between AGs (AG1 = 0.89 vs AG2 = 0.91 vs AG3 = 0.95), with AG1 and AG2 significantly less specific than AG3. Conclusions STEMI diagnostic algorithms vary in regards to their validity in identifying patients with culprit artery lesions. This suggests that systems could apply more sensitive or specific algorithms depending on the needs in their community.

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“…12,22,24 The addition of paramedic or physician review of the ECG can improve accuracy and allows inclusion of the patient's symptoms and medical history, and prior ECGs when available, in the decision process. 25,26 Interestingly, on review of the ECGs, 18% of those initially classified as FP had an ischemic ST pattern suggestive of a possible acute coronary occlusion. From a systems perspective, this can be considered an appropriate trigger for CCL activation.…”

Section: Discussionmentioning

confidence: 99%

Causes of Prehospital Misinterpretations of ST Elevation Myocardial Infarction

Bosson¹,

Sanko²,

Stickney³

et al. 2016

Prehospital Emergency Care

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To determine the causes of software misinterpretation of ST elevation myocardial infarction (STEMI) compared to clinically identified STEMI to identify opportunities to improve prehospital STEMI identification. Methods: We compared ECGs acquired from July through June 2012 using the LIFEPAK 15 on adult patients transported by the Los Angeles Fire Department. Cases included patients ≥18 years who received a prehospital ECG. Software interpretation of the ECG (STEMI or not) was compared with data in the regional EMS registry to classify the interpretation as true positive (TP), true negative (TN), false positive (FP), or false negative (FN). For cases where classification was not possible using registry data, 3 blinded cardiologists interpreted the ECG. Each discordance was subsequently reviewed to determine the likely cause of misclassification. The cardiologists independently reviewed a sample of these discordant ECGs and the causes of misclassification were updated in an iterative fashion. Results: Of 44,611 cases, 50% were male (median age 65; inter-quartile range 52-80). Cases were classified as 482 (1.1%) TP, 711 (1.6%) FP, 43371 (97.2%) TN, and 47 (0.11%) FN. Of the 711 classified as FP, 126 (18%) were considered appropriate for, though did not undergo, emergent coronary angiography, because the ECG showed definite (52 cases) or borderline (65 cases) ischemic ST elevation, a STEMI equivalent (5 cases) or ST-elevation due to vasospasm (4 cases). The sensitivity was 92.8% [95%CI 90.6, 94.7%] and the specificity 98.7% [95%CI 98.6, 98.8%]. The leading causes of FP were ECG artifact (20%), early repolarization (16%), probable pericarditis/myocarditis (13%), indeterminate (12%), left ventricular hypertrophy (8%), and right bundle branch block (5%). There were 18 additional reasons for FP interpretation (< 4% each). The leading causes of FN were borderline ST-segment elevations less than the algorithm threshold (40%) and tall T waves reducing the ST/T ratio below threshold (15%). There were 11 additional reasons for FN interpretation occurring ≤3 times each. Conclusion: The leading causes of FP automated interpretation of STEMI were ECG artifact and non-ischemic causes of ST-segment elevation. FN were rare and were related to STsegment elevation or ST/T ratio that did not meet the software algorithm threshold.

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The availability of prior ECGs improves paramedic accuracy in recognizing ST-segment elevation myocardial infarction

Abstract: Abstract:Introduction: Early and accurate identification of ST-Elevation Myocardial Infarction (STEMI)

Cited by 17 publications

References 19 publications

Paramedic versus physician-staffed ambulances and prehospital delays in the management of patients with ST-segment elevation myocardial infarction

Paramedic versus physician-staffed ambulances and prehospital delays in the management of patients with ST-segment elevation myocardial infarction

Electrocardiographic diagnosis of ST segment elevation myocardial infarction: An evaluation of three automated interpretation algorithms

Causes of Prehospital Misinterpretations of ST Elevation Myocardial Infarction

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