> Detailanzeige

Yiadom, Maame Yaa A. B.; Baugh, Christopher W.; McWade, Conor M.; Liu, Xulei; Song, Kyoung Jun; Patterson, Brian W.; Jenkins, Cathy A.; Tanski, Mary; Mills, Angela M.; Salazar, Gilberto; Wang, Thomas J.; Dittus, Robert S.; Liu, Dandan; Storrow, Alan B.

Performance of Emergency Department Screening Criteria for an Early ECG to Identify ST‐Segment Elevation Myocardial Infarction

Literatur-
verwaltung

Zur
Merkliste

Lösche von
Merkliste

Per Whatsapp teilen

Schließen

Merkliste



Sie können Bookmarks mittels Listen verwalten, loggen Sie sich dafür bitte in Ihr SLUB Benutzerkonto ein.
  • Medientyp: E-Artikel
  • Titel: Performance of Emergency Department Screening Criteria for an Early ECG to Identify ST‐Segment Elevation Myocardial Infarction
  • Beteiligte: Yiadom, Maame Yaa A. B.; Baugh, Christopher W.; McWade, Conor M.; Liu, Xulei; Song, Kyoung Jun; Patterson, Brian W.; Jenkins, Cathy A.; Tanski, Mary; Mills, Angela M.; Salazar, Gilberto; Wang, Thomas J.; Dittus, Robert S.; Liu, Dandan; Storrow, Alan B.
  • Erschienen: Ovid Technologies (Wolters Kluwer Health), 2017
  • Erschienen in: Journal of the American Heart Association
  • Sprache: Englisch
  • DOI: 10.1161/jaha.116.003528
  • ISSN: 2047-9980
  • Schlagwörter: Cardiology and Cardiovascular Medicine
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:sec xml:lang="en"> <jats:title>Background</jats:title> <jats:p xml:lang="en"> Timely diagnosis of <jats:styled-content style="fixed-case">ST</jats:styled-content> ‐segment elevation myocardial infarction ( <jats:styled-content style="fixed-case">STEMI</jats:styled-content> ) in the emergency department ( <jats:styled-content style="fixed-case">ED</jats:styled-content> ) is made solely by <jats:styled-content style="fixed-case">ECG</jats:styled-content> . Obtaining this test within 10 minutes of <jats:styled-content style="fixed-case">ED</jats:styled-content> arrival is critical to achieving the best outcomes. We investigated variability in the timely identification of <jats:styled-content style="fixed-case">STEMI</jats:styled-content> across institutions and whether performance variation was associated with the <jats:styled-content style="fixed-case">ED</jats:styled-content> characteristics, the comprehensiveness of screening criteria, and the <jats:styled-content style="fixed-case">STEMI</jats:styled-content> screening processes. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Methods and Results</jats:title> <jats:p xml:lang="en"> We examined <jats:styled-content style="fixed-case">STEMI</jats:styled-content> screening performance in 7 <jats:styled-content style="fixed-case">ED</jats:styled-content> s, with the missed case rate ( <jats:styled-content style="fixed-case">MCR</jats:styled-content> ) as our primary end point. The <jats:styled-content style="fixed-case">MCR</jats:styled-content> is the proportion of primarily screened <jats:styled-content style="fixed-case">ED</jats:styled-content> patients diagnosed with <jats:styled-content style="fixed-case">STEMI</jats:styled-content> who did not receive an <jats:styled-content style="fixed-case">ECG</jats:styled-content> within 15 minutes of <jats:styled-content style="fixed-case">ED</jats:styled-content> arrival. <jats:styled-content style="fixed-case">STEMI</jats:styled-content> was defined by hospital discharge diagnosis. Relationships between the <jats:styled-content style="fixed-case">MCR</jats:styled-content> and <jats:styled-content style="fixed-case">ED</jats:styled-content> characteristics, screening criteria, and <jats:styled-content style="fixed-case">STEMI</jats:styled-content> screening processes were assessed, along with differences in door‐to‐ <jats:styled-content style="fixed-case">ECG</jats:styled-content> times for captured versus missed patients. The overall <jats:styled-content style="fixed-case">MCR</jats:styled-content> for all 7 <jats:styled-content style="fixed-case">ED</jats:styled-content> s was 12.8%. The lowest and highest <jats:styled-content style="fixed-case">MCR</jats:styled-content> s were 3.4% and 32.6%, respectively. The mean difference in door‐to‐ <jats:styled-content style="fixed-case">ECG</jats:styled-content> times for captured and missed patients was 31 minutes, with a range of 14 to 80 minutes of additional myocardial ischemia time for missed cases. The prevalence of primarily screened <jats:styled-content style="fixed-case">ED STEMI</jats:styled-content> s was 0.09%. <jats:styled-content style="fixed-case">ED</jats:styled-content> s with the greatest <jats:italic>informedness</jats:italic> (sensitivity+specificity−1) demonstrated superior performance across all other screening measures. </jats:p> </jats:sec> <jats:sec xml:lang="en"> <jats:title>Conclusions</jats:title> <jats:p xml:lang="en"> The 29.2% difference in <jats:styled-content style="fixed-case">MCRs</jats:styled-content> between the highest and lowest performing <jats:styled-content style="fixed-case">ED</jats:styled-content> s demonstrates room for improving timely <jats:styled-content style="fixed-case">STEMI</jats:styled-content> identification among primarily screened <jats:styled-content style="fixed-case">ED</jats:styled-content> patients. The <jats:styled-content style="fixed-case">MCR</jats:styled-content> and informedness can be used to compare screening across <jats:styled-content style="fixed-case">ED</jats:styled-content> s and to understand variable performance. </jats:p> </jats:sec>
  • Zugangsstatus: Freier Zugang