Aufderheide T P, Hendley G E, Thakur R K, Mateer J R, Stueven H A, Olson D W, Hargarten K M, Laitinen F, Robinson N, Preuss K C
Department of Emergency Medicine, College of Wisconsin, Milwaukee.
Ann Emerg Med. 1990 Nov;19(11):1280-7. doi: 10.1016/s0196-0644(05)82288-7.
It is feasible to apply prehospital 12-lead electrocardiography to most stable prehospital chest pain patients. Prehospital diagnostic accuracy is improved compared with single-lead telemetry.
One-hundred sixty-six stable adult patients who sought paramedic evaluation for a chief complaint of nontraumatic chest pain.
One-hundred fifty-one prehospital 12-lead ECGs of diagnostic quality were obtained by paramedics on 166 adult patients presenting with nontraumatic chest pain. Paramedics and base station physicians were blinded to the information on acquired prehospital 12-lead ECGs and treated patients according to current standard of care-clinical diagnosis and single-lead telemetry. Final hospital diagnoses were classified into three groups: acute myocardial infarction (24); suspected angina or ischemia (61); and nonischemic chest pain (66). Paramedics and base station physicians' clinical diagnoses and prehospital and emergency department ECGs were similarly classified and compared. Prehospital and ED 12-lead ECGs were read retrospectively by two cardiologists.
Paramedics achieved a high success rate (98.7%) in obtaining diagnostic quality prehospital 12-lead ECGs in 94.6% of eligible prehospital patients. For patients with acute myocardial infarction, prehospital ECG alone had significantly higher specificity than did the paramedic clinical diagnosis (99.2% vs 70.9%; P less than .001), and significantly higher positive predictive value (92.9% vs 32.7%; P less than .001). For patients with angina, combining the paramedic clinical diagnosis and the prehospital ECG significantly improved sensitivity (90.2% vs 62.3%; P less than .001) and increased negative predictive value (88.9% vs 71.3%; P less than .02) compared with paramedic clinical diagnosis alone. There was a high concordance between prehospital and ED ECG diagnosis (99.3% for acute myocardial infarction and 92.8% for angina). Furthermore, ten patients whose prehospital ECGs demonstrated ischemia and who had final hospital diagnoses of angina or acute myocardial infarction were mistriaged by paramedics and/or received no base station physician-directed therapy.
It is feasible to apply prehospital 12-lead electrocardiography to most stable prehospital chest pain patients. Prehospital 12-lead ECGs have the potential to significantly increase the diagnostic accuracy in chest pain patients, approach congruity with ED 12-lead ECG diagnoses, and may allow for consideration of altering and improving prehospital and hospital-based management in this patient population.
对大多数病情稳定的院前胸痛患者应用院前12导联心电图是可行的。与单导联遥测相比，院前诊断准确性有所提高。
166名因非创伤性胸痛为主诉寻求护理人员评估的成年稳定患者。
护理人员为166名出现非创伤性胸痛的成年患者获取了151份具有诊断质量的院前12导联心电图。护理人员和基地医院医生对获取的院前12导联心电图信息不知情，并根据当前的护理标准——临床诊断和单导联遥测对患者进行治疗。最终的医院诊断分为三组：急性心肌梗死（24例）；疑似心绞痛或缺血（61例）；以及非缺血性胸痛（66例）。对护理人员和基地医院医生的临床诊断以及院前和急诊科心电图进行了类似的分类和比较。两名心脏病专家对院前和急诊科的12导联心电图进行了回顾性解读。
护理人员在94.6%符合条件的院前患者中成功获取具有诊断质量的院前12导联心电图的成功率为98.7%。对于急性心肌梗死患者，仅院前心电图的特异性显著高于护理人员的临床诊断（99.2%对70.9%；P<0.001），阳性预测值也显著更高（92.9%对32.7%；P<0.001）。对于心绞痛患者，与仅护理人员的临床诊断相比，将护理人员的临床诊断与院前心电图相结合可显著提高敏感性（90.2%对62.3%；P<0.001）并增加阴性预测值（88.9%对71.3%；P<0.02）。院前和急诊科心电图诊断之间具有高度一致性（急性心肌梗死为99.3%，心绞痛为92.8%）。此外，10例院前心电图显示缺血且最终医院诊断为心绞痛或急性心肌梗死的患者被护理人员误诊和/或未接受基地医院医生指导的治疗。
对大多数病情稳定的院前胸痛患者应用院前12导联心电图是可行的。院前12导联心电图有可能显著提高胸痛患者的诊断准确性，使其与急诊科12导联心电图诊断趋于一致，并可能有助于考虑改变和改善该患者群体的院前和院内管理。
