Clinical and Experimental Emergency Medicine

대한응급의학회 (The Korean Society of Emergency Medicine)
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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)
  • 투고 : 2017.07.27
  • 심사 : 2017.09.26
  • 발행 : 2018.12.31
⟨ 이전 논문 다음 논문 ⟩

초록

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.

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과제정보

연구 과제 주관 기관 : Woochon Cardio-Neuro-Vascular Research Foundation

참고문헌

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