The Positive Predictive Value of Paramedic Versus Emergency Physician Interpretation of the Prehospital 12-Lead Electrocardiogram

Abstract

Transmission to the ED for EP interpretation improves the PPV of the prehospital 12-lead ECG for triage and therapeutic decision-making.

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

“…It is unclear if our results could be extrapolated to other EMS systems. Finally, the accuracy (75-80%) and sensitivity is below that previously reported in the literature 6,8 . A potential reason for this could be attributed to the simulated environment or due to the removal of the computer ECG interpretation.…”

“…False activations by paramedics can lead to an increase in medical care costs and general mistrust by emergency physicians and cardiologists. Davis et al demonstrated that while paramedics are proficient at ECG interpretation, transmission of prehospital ECGs to Emergency physicians improves the positive predictive value of the ECG for therapeutic decision-making 6 . This study, combined with the growing body of literature suggests that leaders in out-of-hospital care should further investigate strategies to maximize prehospital provider accuracy in STEMI identification.…”

“…5 Current literature suggests that paramedics can accurately identify a STEMI on ECG. [6][7][8][9] Despite this growing body of literature, there are still concerns among hospital providers over potential false prehospital cardiac catheterization laboratory activations 10 . False activations by paramedics can lead to an increase in medical care costs and general mistrust by emergency physicians and cardiologists.…”

Decision-Support Tool in Prehospital Care: A Systematic Review of Randomized Trials

“…25,33,36,47,48,53 Interventions of prehospital cardiac care were evaluated in five studies, and three studies investigated the impact of prehospital 12-lead electrocardiograms (ECGs). 26,27,30 One study investigated prehospital AMI diagnosis, 53 and a study evaluate protocol for percutaneous coronary intervention (PCI) bypass. 30 The majority of these studies demonstrate a positive correlation between DST and impact on patient assessment.…”

“…There could have been a risk that the volunteer group consisted of more interested and qualified personnel, and this may have influenced the results. In eight other studies, [26][27][28][29][30][31][32][33] the intervention was compared with a retrospective control group. They all also demonstrated a significant favor toward the intervention group, but it is difficult to determine if the two compared groups were homogeneous enough to draw any conclusions.…”