Alrumayh Abdullah A, Mubarak Abdullah M, Almazrua Abdulkarim A, Alharthi Musab Z, Alatef Deem F, Albacker Turki B, Samarkandy Fahad M, Alsofayan Yousef M, Alobaida Muath
Department of Basic Sciences, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia.
Department of Aviation and Marine, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia.
J Multidiscip Healthc. 2022 Aug 4;15:1657-1665. doi: 10.2147/JMDH.S371877. eCollection 2022.
To evaluate paramedic ability in recognizing 12-lead Electrocardiogram (ECG) with ST-segment Elevation myocardial infarction (STEMI) in Saudi Arabia.
This is a quantitative exploratory cross-sectional study using an electronic survey of paramedics was conducted between June and September 2021. The survey included demographics, educational and clinical experiences, and multiple 12-lead ECG strip questions to assess participants' ability to recognize STEMI. We reported the overall sensitivity, specificity, and correct proportions with 95% Confidence Intervals (CI).
Eighty-four paramedics completed the survey, and 65% of them were between 24 and 29 years old, with a median, of three years of field experience. Overall sensitivity and specificity were 58.39% (95% CI, 50.4% to 66.1%) and 29.01% (95% CI, 25.15% to 33.1%), respectively. In total, 67.1% correctly identified inferior STEMI, whereas only 50% correctly identified lateral STEMI. Both STEMIs were correctly identified by 41%, and the majority misinterpreted STEMI mimics (ECG rhythms with similar ECG morphology to STEMI). The proportion who correctly recognized left bundle branch block was 14.8%, pericarditis was 10.9%, and ventricular pacing was 1.4%. However, almost third of participants correctly identified right bundle branch block (32.9%) and left ventricle hypertrophy (30.7%). Overall, there was no correlation between the correct ECG interpretation of STEMIs and educational and clinical experiences.
Paramedics were able to identify STEMI events in prehospital settings with moderate sensitivity and low specificity with limited ability to differentiate between STEMI and STEMI mimics. Therefore, additional training in ECG interpretation could improve their clinical decision-making, and to ensure that proper care and treatment is provided. Further research on a large, representative sample of paramedics across the country could provide more definitive evidence to establish a greater degree of accuracy in detecting STEMI in prehospital settings.
评估沙特阿拉伯护理人员识别12导联心电图（ECG）诊断ST段抬高型心肌梗死（STEMI）的能力。
这是一项定量探索性横断面研究，于2021年6月至9月对护理人员进行电子问卷调查。调查内容包括人口统计学、教育和临床经验，以及多个12导联心电图条带问题，以评估参与者识别STEMI的能力。我们报告了总体敏感性、特异性和正确比例，并给出95%置信区间（CI）。
84名护理人员完成了调查，其中65%年龄在24至29岁之间，中位现场经验为三年。总体敏感性和特异性分别为58.39%（95%CI，50.4%至66.1%）和29.01%（95%CI，25.15%至33.1%）。总体而言，67.1%的人正确识别了下壁STEMI，而只有50%的人正确识别了侧壁STEMI。两种STEMI均被41%的人正确识别，大多数人错误解读了STEMI模拟物（心电图节律与STEMI心电图形态相似）。正确识别左束支传导阻滞的比例为14.8%，心包炎为10.9%，心室起搏为1.4%。然而，近三分之一的参与者正确识别了右束支传导阻滞（32.9%）和左心室肥厚（30.7%）。总体而言，对STEMI的正确心电图解读与教育和临床经验之间没有相关性。
护理人员能够在院前环境中以中等敏感性和低特异性识别STEMI事件，区分STEMI和STEMI模拟物的能力有限。因此，额外的心电图解读培训可以改善他们的临床决策，并确保提供适当的护理和治疗。对全国大量具有代表性的护理人员样本进行进一步研究，可以提供更确凿的证据，以在院前环境中更高程度地准确检测STEMI。
