Clinical and Experimental Emergency Medicine

The Korean Society of Emergency Medicine (대한응급의학회)
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Sensitivity, specificity, and predictive value of cardiac symptoms assessed by emergency medical services providers in the diagnosis of acute myocardial infarction: a multi-center observational study

  • Park, Jeong Ho (Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute) ;
  • Moon, Sung Woo (Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute) ;
  • Kim, Tae Yun (Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute) ;
  • Ro, Young Sun (Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute) ;
  • Cha, Won Chul (Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute) ;
  • Kim, Yu Jin (Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute) ;
  • Shin, Sang Do (Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute)
  • Received : 2017.07.27
  • Accepted : 2017.09.26
  • Published : 2018.12.31
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Abstract

Objective For patients with acute myocardial infarction (AMI), symptoms assessed by emergency medical services (EMS) providers have a critical role in prehospital treatment decisions. The purpose of this study was to evaluate the diagnostic accuracy of EMS provider-assessed cardiac symptoms of AMI. Methods Patients transported by EMS to 4 study hospitals from 2008 to 2012 were included. Using EMS and administrative emergency department databases, patients were stratified according to the presence of EMS-assessed cardiac symptoms and emergency department diagnosis of AMI. Cardiac symptoms were defined as chest pain, dyspnea, palpitations, and syncope. Disproportionate stratified sampling was used, and medical records of sampled patients were reviewed to identify an actual diagnosis of AMI. Using inverse probability weighting, verification bias-corrected diagnostic performance was estimated. Results Overall, 92,353 patients were enrolled in the study. Of these, 13,971 (15.1%) complained of cardiac symptoms to EMS providers. A total of 775 patients were sampled for hospital record review. The sensitivity, specificity, positive predictive value, and negative predictive value of EMS provider-assessed cardiac symptoms for the final diagnosis of AMI was 73.3% (95% confidence interval [CI], 70.8 to 75.7), 85.3% (95% CI, 85.3 to 85.4), 3.9% (95% CI, 3.6 to 4.2), and 99.7% (95% CI, 99.7 to 99.8), respectively. Conclusion We found that EMS provider-assessed cardiac symptoms had moderate sensitivity and high specificity for diagnosis of AMI. EMS policymakers can use these data to evaluate the pertinence of specific prehospital treatment of AMI.

Keywords

Acknowledgement

Supported by : Woochon Cardio-Neuro-Vascular Research Foundation

References

  1. Castelli WP, Garrison RJ, Wilson PW, Abbott RD, Kalousdian S, Kannel WB. Incidence of coronary heart disease and lipoprotein cholesterol levels. The Framingham Study. JAMA 1986; 256:2835-8. https://doi.org/10.1001/jama.1986.03380200073024
  2. Levi F, Chatenoud L, Bertuccio P, Lucchini F, Negri E, La Vecchia C. Mortality from cardiovascular and cerebrovascular diseases in Europe and other areas of the world: an update. Eur J Cardiovasc Prev Rehabil 2009;16:333-50. https://doi.org/10.1097/HJR.0b013e328325d67d
  3. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2197-223. https://doi.org/10.1016/S0140-6736(12)61689-4
  4. Steg PG, Bonnefoy E, Chabaud S, et al. Impact of time to treatment on mortality after prehospital fibrinolysis or primary angioplasty: data from the CAPTIM randomized clinical trial. Circulation 2003;108:2851-6. https://doi.org/10.1161/01.CIR.0000103122.10021.F2
  5. Ryan TJ, Anderson JL, Antman EM, et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction: executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Circulation 1996;94:2341-50. https://doi.org/10.1161/01.CIR.94.9.2341
  6. Canto JG, Zalenski RJ, Ornato JP, et al. Use of emergency medical services in acute myocardial infarction and subsequent quality of care: observations from the National Registry of Myocardial Infarction 2. Circulation 2002;106:3018-23. https://doi.org/10.1161/01.CIR.0000041246.20352.03
  7. Park YH, Kang GH, Song BG, et al. Factors related to prehospital time delay in acute ST-segment elevation myocardial infarction. J Korean Med Sci 2012;27:864-9. https://doi.org/10.3346/jkms.2012.27.8.864
  8. Morrison LJ, Brooks S, Sawadsky B, McDonald A, Verbeek PR. Prehospital 12-lead electrocardiography impact on acute myocardial infarction treatment times and mortality: a systematic review. Acad Emerg Med 2006;13:84-9. https://doi.org/10.1197/j.aem.2005.07.042
  9. Brainard AH, Raynovich W, Tandberg D, Bedrick EJ. The prehospital 12-lead electrocardiogram's effect on time to initiation of reperfusion therapy: a systematic review and meta-analysis of existing literature. Am J Emerg Med 2005;23:351-6. https://doi.org/10.1016/j.ajem.2005.02.004
  10. Cone DC, Lee CH, Van Gelder C. EMS activation of the cardiac catheterization laboratory is associated with process improvements in the care of myocardial infarction patients. Prehosp Emerg Care 2013;17:293-8. https://doi.org/10.3109/10903127.2013.773112
  11. Squire BT, Tamayo-Sarver JH, Rashi P, Koenig W, Niemann JT. Effect of prehospital cardiac catheterization lab activation on door-to-balloon time, mortality, and false-positive activation. Prehosp Emerg Care 2014;18:1-8.
  12. European Myocardial Infarction Project Group. Prehospital thrombolytic therapy in patients with suspected acute myocardial infarction. N Engl J Med 1993;329:383-9. https://doi.org/10.1056/NEJM199308053290602
  13. Morrison LJ, Verbeek PR, McDonald AC, Sawadsky BV, Cook DJ. Mortality and prehospital thrombolysis for acute myocardial infarction: a meta-analysis. JAMA 2000;283:2686-92. https://doi.org/10.1001/jama.283.20.2686
  14. O'Connor RE, Al Ali AS, Brady WJ, et al. Part 9: acute coronary syndromes. 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015;132(18 Suppl 2):S483-500. https://doi.org/10.1161/CIR.0000000000000263
  15. Bruyninckx R, Aertgeerts B, Bruyninckx P, Buntinx F. Signs and symptoms in diagnosing acute myocardial infarction and acute coronary syndrome: a diagnostic meta-analysis. Br J Gen Pract 2008;58:105-11.
  16. Shin SD, Ahn KO, Song KJ, Park CB, Lee EJ. Out-of-hospital airway management and cardiac arrest outcomes: a propensity score matched analysis. Resuscitation 2012;83:313-9. https://doi.org/10.1016/j.resuscitation.2011.10.028
  17. Shin SD, Suh GJ, Ahn KO, Song KJ. Cardiopulmonary resuscitation outcome of out-of-hospital cardiac arrest in low-volume versus high-volume emergency departments: an observational study and propensity score matching analysis. Resuscitation 2011;82:32-9. https://doi.org/10.1016/j.resuscitation.2010.08.031
  18. Katki HA, Li Y, Edelstein DW, Castle PE. Estimating the agreement and diagnostic accuracy of two diagnostic tests when one test is conducted on only a subsample of specimens. Stat Med 2012;31:436-48. https://doi.org/10.1002/sim.4422
  19. Gravitt PE, Paul P, Katki HA, et al. Effectiveness of VIA, Pap, and HPV DNA testing in a cervical cancer screening program in a peri-urban community in Andhra Pradesh, India. PLoS One 2010;5:e13711. https://doi.org/10.1371/journal.pone.0013711
  20. Ferreccio C, Barriga MI, Lagos M, et al. Screening trial of human papillomavirus for early detection of cervical cancer in Santiago, Chile. Int J Cancer 2013;132:916-23. https://doi.org/10.1002/ijc.27662
  21. Mathew TP, Menown IB, McCarty D, Gracey H, Hill L, Adgey AA. Impact of pre-hospital care in patients with acute myocardial infarction compared with those first managed in-hospital. Eur Heart J 2003;24:161-71.
  22. Coventry LL, Bremner AP, Williams TA, Jacobs IG, Finn J. Symptoms of myocardial infarction: concordance between paramedic and hospital records. Prehosp Emerg Care 2014;18:393-401. https://doi.org/10.3109/10903127.2014.891064
  23. Rawshani A, Larsson A, Gelang C, et al. Characteristics and outcome among patients who dial for the EMS due to chest pain. Int J Cardiol 2014;176:859-65. https://doi.org/10.1016/j.ijcard.2014.08.004
  24. Lambert L, Brown K, Segal E, Brophy J, Rodes-Cabau J, Bogaty P. Association between timeliness of reperfusion therapy and clinical outcomes in ST-elevation myocardial infarction. JAMA 2010;303:2148-55. https://doi.org/10.1001/jama.2010.712
  25. Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med 2010;362:2155-65. https://doi.org/10.1056/NEJMoa0908610