Ho Andrew Fu Wah, Pek Pin Pin, Fook-Chong Stephanie, Wong Ting Hway, Ng Yih Yng, Wong Aaron Sung Lung, Ong Marcus Eng Hock
Singhealth Emergency Medicine Residency Program, Singapore Health Services, Singapore.
Department of Emergency Medicine, Singapore General Hospital, Singapore.
World J Emerg Med. 2015;6(4):277-82. doi: 10.5847/wjem.j.1920-8642.2015.04.005.
Timely reperfusion in ST-segment elevation myocardial infarction (STEMI) improves outcomes. System delay is that between first medical contact and reperfusion therapy, comprising prehospital and hospital components. This study aimed to characterize prehospital system delay in Singapore.
A retrospective chart review was performed for 462 consecutive STEMI patients presenting to a tertiary hospital from December 2006 to April 2008. Patients with cardiac arrest secondarily presented were excluded. For those who received emergency medical services (EMS), ambulance records were reviewed. Time intervals in the hospital were collected prospectively. The patients were divided into two equal groups of high/low prehospital system delay using visual binning technique.
Of 462 patients, 76 received EMS and 52 of the 76 patients were analyzed. The median system delay was 125.5 minutes and the median prehospital system delay was 33.5 minutes (interquartile range [IQR]=27.0, 42.0). Delay between call-received-by-ambulance and ambulance-dispatched was 2.48 minutes (IQR=1.47, 16.55); between ambulance-dispatch and arrival-at-patient-location was 8.07 minutes (IQR=1.30, 22.13); between arrival-at- and departure-from-patient-location was 13.12 minutes (IQR=3.12, 32.2); and between leaving-patient-location to ED-registration was 9.90 minutes (IQR=1.62, 32.92). Comparing patients with prehospital system delay of less than 35.5 minutes versus more showed that the median delay between ambulance-dispatch and arrival-at-patient-location was shorter (5.75 vs. 9.37 minutes, P<0.01). The median delay between arrival-at-patient-location and leaving-patient-location was also shorter (10.78 vs. 14.37 minutes, P<0.01).
Prehospital system delay in our patients was suboptimal. This is the first attempt at characterizing prehospital system delay in Singapore and forms the basis for improving efficiency of STEMI care.
ST段抬高型心肌梗死（STEMI）的及时再灌注可改善预后。系统延迟是指首次医疗接触与再灌注治疗之间的时间，包括院前和院内部分。本研究旨在描述新加坡的院前系统延迟情况。
对2006年12月至2008年4月期间连续入住一家三级医院的462例STEMI患者进行回顾性病历审查。排除继发心脏骤停的患者。对于接受紧急医疗服务（EMS）的患者，审查救护车记录。前瞻性收集院内时间间隔。采用视觉分组技术将患者分为院前系统延迟高/低两组，每组人数相等。
462例患者中，76例接受了EMS，对这76例患者中的52例进行了分析。系统延迟中位数为125.5分钟，院前系统延迟中位数为33.5分钟（四分位间距[IQR]=27.0，42.0）。救护车接到呼叫至派出的延迟为2.48分钟（IQR=1.47，16.55）；救护车派出至到达患者所在地的延迟为8.07分钟（IQR=1.30，22.13）；到达患者所在地至离开的延迟为13.12分钟（IQR=3.12，32.2）；离开患者所在地至急诊登记的延迟为9.90分钟（IQR=1.62，32.92）。比较院前系统延迟小于35.5分钟和大于35.5分钟的患者，结果显示救护车派出至到达患者所在地的延迟中位数较短（5.75对9.37分钟，P<0.01）。到达患者所在地至离开的延迟中位数也较短（10.78对14.37分钟，P<0.01）。
我们患者的院前系统延迟情况欠佳。这是首次对新加坡的院前系统延迟进行描述，为提高STEMI治疗效率奠定了基础。
