An algorithm for identification of ST-elevation myocardial infarction patients by emergency medicine services.
Am J Emerg Med
; 31(7): 1098-102, 2013 Jul.
Article
em En
| MEDLINE
| ID: mdl-23706572
ABSTRACT
OBJECTIVE:
ST-elevation myocardial infarction (STEMI) identification by emergency medicine services (EMS) leading to pre-hospital catheterization laboratory (CL) activation shortens ischemic time and improves outcomes. We examined the incremental value of addition of a screening clinical tool (CT), containing clinical information and a Zoll electrocardiogram (ECG)-resident STEMI identification program (ZI) to ZI alone.METHODS:
All EMS-performed and ZI-analyzed ECGs transmitted to a percutaneous coronary intervention hospital from October 2009 to January 2011 were reviewed for diagnostic accuracy. ZI performance was also compared to ECG interpretations by 2 experienced readers The CT was then retrospectively applied to determine the incremental benefit above the ZI alone.RESULTS:
ST-elevation myocardial infarction was confirmed in 23 (7.5%) of 305 patients. ZI was positive in 37 (12.1%) sensitivity 95.6% and specificity 94.6%, positive predictive value (PPV), 59.5%, negative predictive value (NPV), 99.6%, and accuracy of 93.8%. Moderate agreement was observed among the readers and ZI. CT criteria for CL activation were met in 24 (7.8%) 20 (83.3%) were confirmed STEMIs sensitivity 86.9%, specificity 98.5%, a PPV 83.3%, and NPV 98.6%, accuracy of 97.7%. CT + ZI increased PPV (P<0.05) and specificity (P<0.003) by reducing false positive STEMI identifications from 15 (4.9%) to 4 (1.3%).CONCLUSIONS:
In an urban cohort of all EMS transmitted ECGs, ZI has high sensitivity and specificity for STEMI identification. Whereas the PPV was low, reflecting both low STEMI prevalence and presence of STEMI-mimics, the NPV was very high. These findings suggest that a simplified CT combined with computer STEMI interpretation can identify patients for pre-hospital CL activation. Confirmation of these results could improve the design of STEMI care systems.
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Algoritmos
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Tomada de Decisões Assistida por Computador
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Técnicas de Apoio para a Decisão
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Eletrocardiografia
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Serviços Médicos de Emergência
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Infarto do Miocárdio
Tipo de estudo:
Diagnostic_studies
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Evaluation_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Adolescent
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Adult
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Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Am J Emerg Med
Ano de publicação:
2013
Tipo de documento:
Article
País de afiliação:
Estados Unidos