University of California, Irvine School of Medicine, Department of Emergency Medicine, Orange, CA.
West J Emerg Med. 2009 Nov;10(4):208-12.
In 2005, Orange County California Emergency Medical Services (EMS) initiated a field 12-lead program to minimize time to emergency percutaneous coronary intervention (PCI) for field-identified acute myocardial infarction (MI). As the program matured, "false-positive" (defined as no PCI or coronary artery occlusion upon PCI) field MI activations have been identified as a problem for the program.
To identify potentially correctable factors associated with false-positive EMS triage to PCI centers.
This was a retrospective, outcome study of EMS 12-lead cases from February 2006 to June 2007. The study system exclusively used cardiac monitor internal interpretation algorithms indicating an acute myocardial infarction as the basis for triage. Indicators and variables were defined prior to the study. Data, including outcome, was from the Orange County EMS database, which included copies of 12-lead ECGs used for field triage. Negative odds ratios (OR) of less than 1.0 for positive PCI were the statistical measure of interest.
Five hundred forty-eight patients were triaged from the field for PCI. We excluded 19 cases from the study because of death prior to PCI, refusal of PCI, and co-morbid illness (sepsis, altered consciousness) that precluded PCI. Three hundred ninety-three (74.3%) patients had PCI with significant coronary lesions found. False-positive field triages were associated with underlying cardiac rhythm of sinus tachycardia [OR = 0.38 (95% CI 0.23, 0.62)]; atrial fibrillation [OR = 0.43 (95% CI = 0.20, 0.94)]; an ECG lead not recorded [OR = 0.39 (95% CI = 0.20, 0.76)]; poor ECG baseline [OR = 0.59 (95% CI = 0.25, 1.37)]; One of three brands of monitors used in the field [OR = 0.35 (95% CI = 0.21, 0.59)]; and female gender [OR = 0.50 (95% CI = 0.34, 0.75)]. Age was not associated with false-positive triage as determined by ordinal regression (p=1.00).
For the urban-suburban EMS field 12-lead program studied, age was not associated with false-positive triage. It was unexpected that female gender was associated with false-positive triage. False-positive triage from the field was associated with poor ECG acquisition, underlying rhythms of atrial fibrillation and sinus tachycardia, and one brand of 12-lead monitor.
2005 年，加利福尼亚州奥兰治县的紧急医疗服务（EMS）启动了一项现场 12 导联程序，以尽量减少现场识别出的急性心肌梗死（MI）患者接受紧急经皮冠状动脉介入治疗（PCI）的时间。随着该计划的成熟，已将“假阳性”（定义为在 PCI 时未发现 PCI 或冠状动脉闭塞）的现场 MI 激活确定为该计划的一个问题。
确定与向 PCI 中心分诊的 EMS 假阳性相关的潜在可纠正因素。
这是一项回顾性的结果研究，研究对象为 2006 年 2 月至 2007 年 6 月期间的 EMS 12 导联病例。该研究系统完全使用心脏监测器内部解释算法来指示急性心肌梗死作为分诊的依据。在研究之前定义了指标和变量。数据包括结局，来自奥兰治县 EMS 数据库，其中包括用于现场分诊的 12 导联 ECG 的副本。阳性 PCI 的负比值比（OR）小于 1.0 是感兴趣的统计学测量指标。
共有 548 名患者从现场分诊接受 PCI。由于 PCI 前死亡、拒绝 PCI 以及排除 PCI 的合并疾病（败血症、意识改变），我们从研究中排除了 19 例。393 例（74.3%）患者接受了有明显冠状动脉病变的 PCI。与以下因素相关的现场分诊假阳性包括潜在的窦性心动过速[OR=0.38（95%CI 0.23，0.62）]；心房颤动[OR=0.43（95%CI=0.20，0.94）]；未记录心电图导联[OR=0.39（95%CI=0.20，0.76）]；心电图基线较差[OR=0.59（95%CI=0.25，1.37）]；现场使用的三种品牌监测器之一[OR=0.35（95%CI=0.21，0.59）]；以及女性[OR=0.50（95%CI=0.34，0.75）]。年龄与通过有序回归确定的假阳性分诊无关（p=1.00）。
对于研究中的城市郊区 EMS 现场 12 导联计划，年龄与假阳性分诊无关。出乎意料的是，女性与假阳性分诊有关。现场分诊的假阳性与心电图采集不良、心房颤动和窦性心动过速的潜在节律以及 12 导联监测器的一个品牌有关。
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