التفاصيل البيبلوغرافية
| العنوان: |
A Novel Algorithm for Improving the Prehospital Diagnostic Accuracy of ST-Segment Elevation Myocardial Infarction. |
| المؤلفون: |
Goebel, Mat, Westafer, Lauren M., Ayala, Stephanie A., Ragone, El, Chapman, Scott J., Mohammed, Masood R., Cohen, Marc R., Niemann, James T., Eckstein, Marc, Sanko, Stephen, Bosson, Nichole |
| المصدر: |
Prehospital & Disaster Medicine; Feb2024, Vol. 39 Issue 1, p37-44, 8p |
| مصطلحات موضوعية: |
ST elevation myocardial infarction, EMERGENCY medical services, PERCUTANEOUS coronary intervention |
| مصطلحات جغرافية: |
LOS Angeles (Calif.) |
| مستخلص: |
Introduction: Early detection of ST-segment elevation myocardial infarction (STEMI) on the prehospital electrocardiogram (ECG) improves patient outcomes. Current software algorithms optimize sensitivity but have a high false-positive rate. The authors propose an algorithm to improve the specificity of STEMI diagnosis in the prehospital setting. Methods: A dataset of prehospital ECGs with verified outcomes was used to validate an algorithm to identify true and false-positive software interpretations of STEMI. Four criteria implicated in prior research to differentiate STEMI true positives were applied: heart rate <130, QRS <100, verification of ST-segment elevation, and absence of artifact. The test characteristics were calculated and regression analysis was used to examine the association between the number of criteria included and test characteristics. Results: There were 44,611 cases available. Of these, 1,193 were identified as STEMI by the software interpretation. Applying all four criteria had the highest positive likelihood ratio of 353 (95% CI, 201-595) and specificity of 99.96% (95% CI, 99.93-99.98), but the lowest sensitivity (14%; 95% CI, 11-17) and worst negative likelihood ratio (0.86; 95% CI, 0.84-0.89). There was a strong correlation between increased positive likelihood ratio (r2 = 0.90) and specificity (r2 = 0.85) with increasing number of criteria. Conclusions: Prehospital ECGs with a high probability of true STEMI can be accurately identified using these four criteria: heart rate <130, QRS <100, verification of ST-segment elevation, and absence of artifact. Applying these criteria to prehospital ECGs with software interpretations of STEMI could decrease false-positive field activations, while also reducing the need to rely on transmission for physician over-read. This can have significant clinical and quality implications for Emergency Medical Services (EMS) systems. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
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