DuCharme Brooke, Macci Bires Angela, Montanye Evan, Khan Muhammad, DuCharme Scott, Linse Matthew, Carlson Jestin N
Sciamanda Total Health and Wellness, Erie, Pennsylvania (Dr DuCharme); Robert Morris University, Moon Township, Pennsylvania (Ms Macci Bires); and Emergency Department, Saint Vincent Hospital, Erie, Pennsylvania (Drs Montanye, Khan, DuCharme, and Carlson and Mr Linse).
Crit Care Nurs Q. 2019 Apr/Jun;42(2):208-214. doi: 10.1097/CNQ.0000000000000257.
This article provides research of cardiac biomarkers being drawn in the prehospital setting compared with the emergency department (ED) on intervals critical to the diagnosis of acute myocardial infarction. This is a retrospective chart review of patients brought to the ED of a single, urban teaching hospital by a single emergency medical service (EMS) agency with a chief complaint of "chest pain." We abstracted specific patient characteristics, intervals, positive troponin values, and rates of hemolysis from hospital records utilizing a custom data abstraction tool designed for this study through consensus of the authors. Data were compared between patients who did and did not have prehospital laboratory work performed for cardiac biomarkers utilizing parametric and nonparametric tests when appropriate. Of the initial 49 patients identified, 41 met inclusion criteria; 20 patients (49%) did not have prehospital EMS laboratory results drawn while 21 (51%) patients did have prehospital laboratory results drawn. Overall, 17% (7/41) had positive cardiac biomarkers. The groups were similar with regard to age, gender, race, and medical history. Median time (interquartile range) in minutes, from ED arrival to laboratory results available was shorter for patients with EMS laboratory results compared with those without EMS laboratory results: 53 (45-64) versus 71 (54-95) (P = .02). Time from ED arrival to disposition decision (P = .39) and total ED length of stay (P = .12) were similar between groups. In this preliminary study, prehospital laboratory results were associated with shorter times from ED arrival to the results being available.
本文对在院前环境中采集的心脏生物标志物与急诊科相比在急性心肌梗死诊断的关键时间间隔方面进行了研究。这是一项对由单一紧急医疗服务（EMS）机构送往一家城市教学医院急诊科、主诉为“胸痛”的患者进行的回顾性病历审查。我们使用为该研究设计的定制数据提取工具，通过作者共识从医院记录中提取了特定的患者特征、时间间隔、肌钙蛋白阳性值和溶血率。在适当情况下，对进行了院前心脏生物标志物实验室检查和未进行该项检查的患者的数据进行了参数和非参数检验比较。在最初确定的49例患者中，41例符合纳入标准；20例患者（49%）未获得院前EMS实验室检查结果，而21例患者（51%）有院前实验室检查结果。总体而言，17%（7/41）的患者心脏生物标志物呈阳性。两组在年龄、性别、种族和病史方面相似。与没有EMS实验室检查结果的患者相比，有EMS实验室检查结果的患者从急诊科到达至实验室结果可用的中位时间（四分位间距）以分钟计更短：53（45 - 64）对71（54 - 95）（P = .02）。两组之间从急诊科到达至处置决定的时间（P = .39）和急诊科总住院时间（P = .12）相似。在这项初步研究中，院前实验室检查结果与从急诊科到达至结果可用的时间更短相关。
