| Real-time paramedic compared with blinded physician identification of ST-segment elevation myocardial infarction: results of an observational study. | |
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MedLine Citation:
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PMID: 16032608 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The aim of the study were to determine if paramedics can accurately identify ST-segment elevation myocardial infarction (STEMI) on prehospital 12-lead (PHTL) electrocardiogram and to compare paramedic with blinded physician identification of STEMI. Paramedics identified definite STEMI, or possible acute myocardial infarction but not definite, and nondiagnostic. Two blinded readers (cardiologist and emergency physician) independently categorized each PHTL. A third reviewer assigned final diagnoses and determined whether the PHTL met STEMI criteria. One hundred sixty-six PHTL were acquired over an 8-month period. Fifteen were excluded from analysis. Sixty-two percent of the patients (94/151) were male, mean age was 61.1 years (+/-14.8 SD, range 20-92 years), and 81% had chest pain. Twenty-five patients (16.6%; 95% confidence interval [CI], 11%-23.5%) had confirmed STEMI and 16 (10.6%) had confirmed non-STEMI acute myocardial infarction. Paramedic sensitivity was 0.80 (95% CI, 0.64-0.96); specificity was 0.97 (95% CI, 0.94-1.00) with positive likelihood ratio of 25.2 and negative likelihood ratio of 0.21. Overall accuracy was similar for paramedic and physician reviewers (0.94, 0.93, 0.95). Highly trained paramedics in an urban emergency medical services system can identify patients with STEMI as accurately as blinded physician reviewers. |
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Authors:
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James A Feldman; Kathryn Brinsfield; Sheilah Bernard; Daniel White; Thomas Maciejko |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The American journal of emergency medicine Volume: 23 ISSN: 0735-6757 ISO Abbreviation: Am J Emerg Med Publication Date: 2005 Jul |
Date Detail:
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Created Date: 2005-07-20 Completed Date: 2005-10-07 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8309942 Medline TA: Am J Emerg Med Country: United States |
Other Details:
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Languages: eng Pagination: 443-8 Citation Subset: IM |
Affiliation:
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Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA. jfeldma@bu.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Allied Health Personnel / statistics & numerical data* Chest Pain / etiology Clinical Competence / statistics & numerical data* Diagnostic Errors / statistics & numerical data Electrocardiography / utilization* Emergency Medicine / statistics & numerical data* Female Humans Male Massachusetts Middle Aged Myocardial Infarction / complications, diagnosis* Sensitivity and Specificity |
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