Prehosp Emerg Care. 2019 Nov-Dec;23(6):772-779. doi: 10.1080/10903127.2019.1597230. Epub 2019 Apr 17.
Prehospital electrocardiography (ECG) is recommended for patients with suspected acute coronary syndrome (ACS), yet only 20-80% of chest pain patients receive a prehospital ECG. Less is known about prehospital ECG use in patients with less common complaints (e.g., fatigue) suspicious for ACS who are transported by emergency medical services (EMS). The aims of this study were to determine: (1) the proportion of patients with chest pain and less typical complaints, and (2) patient characteristics associated with prehospital ECG use in patients transported by EMS to emergency departments across North Carolina. A novel linked database was created between prehospital and emergency department (ED) patient care data from the North Carolina Prehospital Medical Information System and the North Carolina Disease Event Tracking and Epidemiologic Collection Tool. Institutional review board approval and a data use agreement were received prior to the start of the study. Patients ≥21 transported during 2010-14 by EMS with select variables were included. We examined patients' complaints (symptoms), characteristics (e.g., race, ethnicity, final hospital diagnosis), and prehospital ECG use (yes/no). Analysis included descriptive statistics and mixed logistic regression. During 2010-14, there were 1,967,542 patients with linked EMS-ED data (mean age: 56.9 [SD: 22.2], 43.2% male, 63.7% White). Of these, 643,174 (32.6%) received a prehospital ECG. Patients with prehospital ECG presented with the following complaints: 20% chest pain; 10% shortness of breath; 6% abdominal pain/problems; 6% altered level of consciousness; 5% syncope/dizziness; 4% palpitations; 12% other complaints; and 37% missing. Patients' presenting complaints were the strongest predictor of prehospital ECG use, adjusting for age, sex, race, ethnicity, urbanicity, and date and time of EMS dispatch. Patients with chest pain were significantly more likely to receive a prehospital ECG compared to those with less typical but suspicious complaints for ACS. Patients with less common presentations remain disadvantaged for early triage, risk stratification, and intervention prior to the hospital.
院前心电图（ECG）推荐用于疑似急性冠状动脉综合征（ACS）的患者，但只有 20-80%的胸痛患者接受了院前 ECG。对于通过紧急医疗服务（EMS）转运的 ACS 可疑但症状不太常见（如疲劳）的患者，院前 ECG 的使用情况了解较少。本研究的目的是确定：（1）胸痛和不典型症状患者的比例，以及（2）与 EMS 转运至北卡罗来纳州急诊科的患者接受院前 ECG 相关的患者特征。创建了一个新的链接数据库，该数据库将来自北卡罗来纳州院前医疗信息系统和北卡罗来纳州疾病事件跟踪和流行病学收集工具的院前和急诊（ED）患者护理数据进行了链接。在研究开始之前，获得了机构审查委员会的批准和数据使用协议。纳入了 2010-14 年期间通过 EMS 转运且具有特定变量的患者。我们检查了患者的症状（症状）、特征（例如，种族、民族、最终医院诊断）和院前 ECG 使用情况（是/否）。分析包括描述性统计和混合逻辑回归。 2010-14 年期间，有 1967542 名患者的 EMS-ED 数据被链接（平均年龄：56.9[SD：22.2]，43.2%为男性，63.7%为白人）。其中，643174 名（32.6%）患者接受了院前 ECG。接受院前 ECG 的患者出现以下症状：20%胸痛；10%呼吸急促；6%腹痛/问题；6%意识水平改变；5%晕厥/头晕；4%心悸；12%其他症状；37%症状缺失。调整年龄、性别、种族、民族、城市性以及 EMS 派遣的日期和时间后，患者的主要症状是院前 ECG 使用的最强预测因素。 胸痛患者与 ACS 可疑但症状不典型的患者相比，更有可能接受院前 ECG。症状不太常见的患者在入院前的早期分诊、风险分层和干预方面仍然处于不利地位。
