A Novel Algorithm for Improving the Diagnostic Accuracy of Prehospital ST-Elevation Myocardial Infarction
ST-segment elevation myocardial infarction (STEMI) is a time-sensitive entity that has been shown to benefit from prehospital diagnosis by electrocardiogram (ECG). Current computer algorithms with binary decision making are not accurate enough to be relied on for cardiac catheterization lab (CCL) ac...
Saved in:
Published in | Prehospital and disaster medicine Vol. 34; no. 5; pp. 489 - 496 |
---|---|
Main Authors | , , , |
Format | Journal Article |
Language | English |
Published |
New York, USA
Cambridge University Press
01.10.2019
Jems Publishing Company, Inc |
Subjects | |
Online Access | Get full text |
Cover
Loading…
Abstract | ST-segment elevation myocardial infarction (STEMI) is a time-sensitive entity that has been shown to benefit from prehospital diagnosis by electrocardiogram (ECG). Current computer algorithms with binary decision making are not accurate enough to be relied on for cardiac catheterization lab (CCL) activation.
An algorithmic approach is proposed to stratify binary STEMI computerized ECG interpretations into low, intermediate, and high STEMI probability tiers.
Based on previous literature, a four-criteria algorithm was developed to rule out/in common causes of prehospital STEMI false-positive computer interpretations: heart rate, QRS width, ST elevation criteria, and artifact. Prehospital STEMI cases were prospectively collected at a single academic center in Salt Lake City, Utah (USA) from May 2012 through October 2013. The prehospital ECGs were applied to the algorithm and compared against activation of the CCL by an emergency department (ED) physician as the outcome of interest. In addition to calculating test characteristics, linear regression was used to look for an association between number of criteria used and accuracy, and logistic regression was used to test if any single criterion performed better than another.
There were 63 ECGs available for review, 39 high probability and 24 intermediate probability. The high probability STEMI tier had excellent test characteristics for ruling in STEMI when all four criteria were used, specificity 1.00 (95% CI, 0.59-1.00), positive predictive value 1.00 (0.91-1.00). Linear regression showed a strong correlation demonstrating that false-positives increased as fewer criteria were used (adjusted r-square 0.51; P <.01). Logistic regression showed no significant predictive value for any one criterion over another (P = .80). Limiting physician overread to the intermediate tier only would reduce the number of ECGs requiring physician overread by a factor of 0.62 (95% CI, 0.48-0.75; P <.01).
Prehospital STEMI ECGs can be accurately stratified to high, intermediate, and low probabilities for STEMI using the four criteria. While additional study is required, using this tiered algorithmic approach in prehospital ECGs could lead to changes in CCL activation and decreased requirements for physician overread. This may have significant clinical and quality implications. |
---|---|
AbstractList | INTRODUCTIONST-segment elevation myocardial infarction (STEMI) is a time-sensitive entity that has been shown to benefit from prehospital diagnosis by electrocardiogram (ECG). Current computer algorithms with binary decision making are not accurate enough to be relied on for cardiac catheterization lab (CCL) activation. HYPOTHESISAn algorithmic approach is proposed to stratify binary STEMI computerized ECG interpretations into low, intermediate, and high STEMI probability tiers. METHODSBased on previous literature, a four-criteria algorithm was developed to rule out/in common causes of prehospital STEMI false-positive computer interpretations: heart rate, QRS width, ST elevation criteria, and artifact. Prehospital STEMI cases were prospectively collected at a single academic center in Salt Lake City, Utah (USA) from May 2012 through October 2013. The prehospital ECGs were applied to the algorithm and compared against activation of the CCL by an emergency department (ED) physician as the outcome of interest. In addition to calculating test characteristics, linear regression was used to look for an association between number of criteria used and accuracy, and logistic regression was used to test if any single criterion performed better than another. RESULTSThere were 63 ECGs available for review, 39 high probability and 24 intermediate probability. The high probability STEMI tier had excellent test characteristics for ruling in STEMI when all four criteria were used, specificity 1.00 (95% CI, 0.59-1.00), positive predictive value 1.00 (0.91-1.00). Linear regression showed a strong correlation demonstrating that false-positives increased as fewer criteria were used (adjusted r-square 0.51; P <.01). Logistic regression showed no significant predictive value for any one criterion over another (P = .80). Limiting physician overread to the intermediate tier only would reduce the number of ECGs requiring physician overread by a factor of 0.62 (95% CI, 0.48-0.75; P <.01). CONCLUSIONPrehospital STEMI ECGs can be accurately stratified to high, intermediate, and low probabilities for STEMI using the four criteria. While additional study is required, using this tiered algorithmic approach in prehospital ECGs could lead to changes in CCL activation and decreased requirements for physician overread. This may have significant clinical and quality implications. Introduction:ST-segment elevation myocardial infarction (STEMI) is a time-sensitive entity that has been shown to benefit from prehospital diagnosis by electrocardiogram (ECG). Current computer algorithms with binary decision making are not accurate enough to be relied on for cardiac catheterization lab (CCL) activation.Hypothesis:An algorithmic approach is proposed to stratify binary STEMI computerized ECG interpretations into low, intermediate, and high STEMI probability tiers.Methods:Based on previous literature, a four-criteria algorithm was developed to rule out/in common causes of prehospital STEMI false-positive computer interpretations: heart rate, QRS width, ST elevation criteria, and artifact. Prehospital STEMI cases were prospectively collected at a single academic center in Salt Lake City, Utah (USA) from May 2012 through October 2013. The prehospital ECGs were applied to the algorithm and compared against activation of the CCL by an emergency department (ED) physician as the outcome of interest. In addition to calculating test characteristics, linear regression was used to look for an association between number of criteria used and accuracy, and logistic regression was used to test if any single criterion performed better than another.Results:There were 63 ECGs available for review, 39 high probability and 24 intermediate probability. The high probability STEMI tier had excellent test characteristics for ruling in STEMI when all four criteria were used, specificity 1.00 (95% CI, 0.59-1.00), positive predictive value 1.00 (0.91-1.00). Linear regression showed a strong correlation demonstrating that false-positives increased as fewer criteria were used (adjusted r-square 0.51; P <.01). Logistic regression showed no significant predictive value for any one criterion over another (P = .80). Limiting physician overread to the intermediate tier only would reduce the number of ECGs requiring physician overread by a factor of 0.62 (95% CI, 0.48-0.75; P <.01).Conclusion:Prehospital STEMI ECGs can be accurately stratified to high, intermediate, and low probabilities for STEMI using the four criteria. While additional study is required, using this tiered algorithmic approach in prehospital ECGs could lead to changes in CCL activation and decreased requirements for physician overread. This may have significant clinical and quality implications. ST-segment elevation myocardial infarction (STEMI) is a time-sensitive entity that has been shown to benefit from prehospital diagnosis by electrocardiogram (ECG). Current computer algorithms with binary decision making are not accurate enough to be relied on for cardiac catheterization lab (CCL) activation. An algorithmic approach is proposed to stratify binary STEMI computerized ECG interpretations into low, intermediate, and high STEMI probability tiers. Based on previous literature, a four-criteria algorithm was developed to rule out/in common causes of prehospital STEMI false-positive computer interpretations: heart rate, QRS width, ST elevation criteria, and artifact. Prehospital STEMI cases were prospectively collected at a single academic center in Salt Lake City, Utah (USA) from May 2012 through October 2013. The prehospital ECGs were applied to the algorithm and compared against activation of the CCL by an emergency department (ED) physician as the outcome of interest. In addition to calculating test characteristics, linear regression was used to look for an association between number of criteria used and accuracy, and logistic regression was used to test if any single criterion performed better than another. There were 63 ECGs available for review, 39 high probability and 24 intermediate probability. The high probability STEMI tier had excellent test characteristics for ruling in STEMI when all four criteria were used, specificity 1.00 (95% CI, 0.59-1.00), positive predictive value 1.00 (0.91-1.00). Linear regression showed a strong correlation demonstrating that false-positives increased as fewer criteria were used (adjusted r-square 0.51; P <.01). Logistic regression showed no significant predictive value for any one criterion over another (P = .80). Limiting physician overread to the intermediate tier only would reduce the number of ECGs requiring physician overread by a factor of 0.62 (95% CI, 0.48-0.75; P <.01). Prehospital STEMI ECGs can be accurately stratified to high, intermediate, and low probabilities for STEMI using the four criteria. While additional study is required, using this tiered algorithmic approach in prehospital ECGs could lead to changes in CCL activation and decreased requirements for physician overread. This may have significant clinical and quality implications. |
Author | Kahn, Christopher Goebel, Mat Vaida, Florin Donofrio, J. Joelle |
Author_xml | – sequence: 1 givenname: Mat orcidid: 0000-0001-8978-1787 surname: Goebel fullname: Goebel, Mat email: mgoebel@gmail.com organization: . University of Massachusetts Medical School – Baystate, Springfield, Massachusetts, USA – sequence: 2 givenname: Florin surname: Vaida fullname: Vaida, Florin organization: . HIV Neurobehavioral Research Program, University of California, San Diego, California, USA – sequence: 3 givenname: Christopher surname: Kahn fullname: Kahn, Christopher organization: . UC San Diego School of Medicine, Department of Emergency Medicine, San Diego, California, USA – sequence: 4 givenname: J. Joelle surname: Donofrio fullname: Donofrio, J. Joelle organization: . UC San Diego School of Medicine, Department of Emergency Medicine, San Diego, California, USA |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31507262$$D View this record in MEDLINE/PubMed |
BookMark | eNp1kU1P3DAQQK0KVL76A7hUlnrpJTBjx4l9XAGFlaBFgkq9RY7j7Bol8dZOVtp_j1csRQL15NHMm2eP54jsDX6whJwinCFgef6AkCtg_A8qgFzm6hM5RJWLDBWXeylO5WxbPyBHMT4BMCVY8ZkccBRQsoIdEjejP_3adnTWLXxw47KnrQ903q-CX7thQcelpZdOLwYfR2fozJgpaLOhvqX3wS59XLlRd_ThMbvq7FqPzg_0buONDo1L-fnQ6mC22ROy3-ou2i-785j8_nH1eHGT3f66nl_MbjPDSz5mKJVRKAvNmDS2FqwGkAC1NkJorFMgFDaAHHiDZRokN3UhJFiJbWsbyY_J9xdvmuDvZONY9S4a23V6sH6KVfLKEgsuWUK_vUOf_BSG9LqKcS4FF8hVovCFMsHHGGxbrYLrddhUCNV2D9WHPaSerzvzVPe2-dfx-vEJ4Dup7uvgmoV9u_v_2mcitJM1 |
CitedBy_id | crossref_primary_10_1017_S1049023X20000606 crossref_primary_10_1017_S1049023X23006635 |
Cites_doi | 10.1016/0895-4356(91)90271-A 10.1080/10903127.2016.1247200 10.21037/atm.2016.06.33 10.1016/0895-4356(90)90064-V 10.1016/j.amjcard.2007.07.082 10.1136/emermed-2015-204988 10.1016/j.jemermed.2017.08.067 10.1111/j.1442-2026.1998.tb00617.x 10.1067/mem.2001.115440 10.3109/10903127.2013.825350 10.3109/10903127.2011.598613 10.1016/0895-4356(92)90124-6 10.1016/j.jelectrocard.2016.04.010 10.1016/j.mayocp.2015.08.021 10.1002/ccd.22257 10.1007/s12630-015-0465-1 10.1016/j.jemermed.2018.04.007 10.1016/0895-4356(91)90065-H 10.2310/8000.2013.131031 10.1056/NEJMoa1208200 10.1016/j.ajem.2004.10.011 10.1016/j.resuscitation.2010.09.001 10.1136/bmjqs-2013-001967 10.1136/bmjqs-2017-007333 10.1080/10903127.2017.1399185 10.1016/j.annemergmed.2015.07.044 10.1093/ije/dyg054 10.3109/10903127.2011.614045 10.1016/j.ajem.2013.04.013 10.1097/ALN.0b013e318225b80a |
ContentType | Journal Article |
Copyright | World Association for Disaster and Emergency Medicine 2019 |
Copyright_xml | – notice: World Association for Disaster and Emergency Medicine 2019 |
DBID | CGR CUY CVF ECM EIF NPM AAYXX CITATION 3V. 7RV 7X7 7XB 88C 88E 8C1 8FI 8FJ 8FK ABUWG AFKRA BENPR CCPQU FYUFA GHDGH K9. KB0 M0S M0T M1P NAPCQ PQEST PQQKQ PQUKI 7X8 |
DOI | 10.1017/S1049023X19004849 |
DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed CrossRef ProQuest Central (Corporate) Nursing & Allied Health Database Health & Medical Collection ProQuest Central (purchase pre-March 2016) Healthcare Administration Database (Alumni) Medical Database (Alumni Edition) Public Health Database (Proquest) Hospital Premium Collection Hospital Premium Collection (Alumni Edition) ProQuest Central (Alumni) (purchase pre-March 2016) ProQuest Central (Alumni) ProQuest Central ProQuest Central ProQuest One Community College Health Research Premium Collection Health Research Premium Collection (Alumni) ProQuest Health & Medical Complete (Alumni) Nursing & Allied Health Database (Alumni Edition) Health & Medical Collection (Alumni Edition) Health Management Database (Proquest) PML(ProQuest Medical Library) Nursing & Allied Health Premium ProQuest One Academic Eastern Edition (DO NOT USE) ProQuest One Academic ProQuest One Academic UKI Edition MEDLINE - Academic |
DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) CrossRef ProQuest Public Health ProQuest One Academic Eastern Edition ProQuest Health & Medical Complete (Alumni) ProQuest Health Management ProQuest Central (Alumni Edition) ProQuest One Community College ProQuest Nursing & Allied Health Source ProQuest Hospital Collection Health Research Premium Collection (Alumni) ProQuest Hospital Collection (Alumni) ProQuest Central Nursing & Allied Health Premium ProQuest Health & Medical Complete Health Research Premium Collection ProQuest Medical Library ProQuest One Academic UKI Edition Health and Medicine Complete (Alumni Edition) ProQuest Health Management (Alumni Edition) ProQuest Nursing & Allied Health Source (Alumni) ProQuest One Academic ProQuest Medical Library (Alumni) ProQuest Central (Alumni) MEDLINE - Academic |
DatabaseTitleList | MEDLINE - Academic ProQuest Public Health MEDLINE |
Database_xml | – sequence: 1 dbid: NPM name: PubMed url: https://proxy.k.utb.cz/login?url=http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: EIF name: MEDLINE url: https://proxy.k.utb.cz/login?url=https://www.webofscience.com/wos/medline/basic-search sourceTypes: Index Database – sequence: 3 dbid: BENPR name: ProQuest Central url: https://www.proquest.com/central sourceTypes: Aggregation Database |
DeliveryMethod | fulltext_linktorsrc |
Discipline | Public Health |
DocumentTitleAlternate | Goebel, Vaida, Kahn, et al Improving the Accuracy of Prehospital STEMI |
EISSN | 1945-1938 |
EndPage | 496 |
ExternalDocumentID | 10_1017_S1049023X19004849 31507262 |
Genre | Evaluation Study Journal Article |
GeographicLocations | Utah United States--US Massachusetts |
GeographicLocations_xml | – name: Utah – name: United States--US – name: Massachusetts |
GroupedDBID | --- -E. ..I .FH 09C 09E 0B8 0E1 0R~ 2WC 3V. 4.4 53G 5VS 74X 74Y 7RV 7X7 7~V 88E 8C1 8FI 8FJ AAAZR AABES AABWE AACJH AAEED AAGFV AAKTX AAQQT AARAB AASVR AAUKB AAWTL ABBXD ABBZL ABGDZ ABJNI ABKKG ABMYL ABOCM ABQTM ABROB ABUWG ABWCF ABXAU ABZCX ABZUI ACBMC ACCHT ACETC ACGFO ACGFS ACIMK ACQFJ ACREK ACUIJ ACUYZ ACWGA ACYZP ACZBM ACZUX ADAZD ADBBV ADDNB ADFEC ADGEJ ADKIL ADOCW ADOVH ADOVT ADVJH AEBAK AEBPU AEHGV AEMTW AENCP AENGE AEPLO AEYHU AEYYC AFFUJ AFKQG AFKRA AFLOS AFLVW AFUTZ AGABE AGJUD AGLWM AGOOT AHLTW AHMBA AHQXX AHRGI AIGNW AIHIV AIOIP AISIE AJCYY AJPFC AJQAS AKZCZ ALMA_UNASSIGNED_HOLDINGS ALVPG ANPSP AQJOH AQUVI ARABE ARZZG ATUCA AUXHV AYIQA AZGZS BBLKV BCGOX BENPR BESQT BGHMG BJBOZ BKEYQ BLZWO BMAJL BPHCQ BQFHP BRIRG BVXVI C0O CBIIA CCPQU CCQAD CCUQV CFAFE CFBFF CGQII CHEAL CJCSC DOHLZ E3Z EBS EGQIC EIHBH EJD EX3 F5P FYUFA HG- HMCUK HST HZ~ I.6 I.7 I.9 IH6 IOEEP IOO IS6 I~P J36 J38 J3A JHPGK JQKCU JVRFK KAFGG KCGVB KFECR L98 LHUNA LW7 M-V M0T M1P M7~ M8. NAPCQ NIKVX NZEOI O9- P2P PQQKQ PROAC PSQYO RCA ROL RR0 S6- S6U SAAAG SJN SY4 T9M TWZ UAP UKHRP UT1 UU6 WFFJZ WOW WQ3 WXU WXY YOJ ZDLDU ZJOSE ZMEZD ZYDXJ ~V1 ABVZP ALIPV CGR CTKSN CUY CVF ECM EIF NPM AAYXX ABVKB ACDLN CITATION 7XB 8FK K9. PQEST PQUKI 7X8 |
ID | FETCH-LOGICAL-c373t-189c9186a228ceb52b00800bac55a1b0ba591d01303d173154cb6580e81ffed83 |
IEDL.DBID | 8C1 |
ISSN | 1049-023X |
IngestDate | Wed Dec 04 00:48:54 EST 2024 Sat Nov 23 07:05:19 EST 2024 Fri Dec 06 01:11:15 EST 2024 Sat Sep 28 08:44:24 EDT 2024 Wed Mar 13 06:03:07 EDT 2024 |
IsPeerReviewed | true |
IsScholarly | true |
Issue | 5 |
Keywords | ECG paramedic STEMI |
Language | English |
License | https://www.cambridge.org/core/terms |
LinkModel | DirectLink |
MergedId | FETCHMERGED-LOGICAL-c373t-189c9186a228ceb52b00800bac55a1b0ba591d01303d173154cb6580e81ffed83 |
Notes | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Undefined-1 ObjectType-Feature-3 content type line 23 |
ORCID | 0000-0001-8978-1787 |
PMID | 31507262 |
PQID | 2338535139 |
PQPubID | 105403 |
PageCount | 8 |
ParticipantIDs | proquest_miscellaneous_2288716382 proquest_journals_2338535139 crossref_primary_10_1017_S1049023X19004849 pubmed_primary_31507262 cambridge_journals_10_1017_S1049023X19004849 |
PublicationCentury | 2000 |
PublicationDate | 20191000 2019-Oct 2019-10-00 20191001 |
PublicationDateYYYYMMDD | 2019-10-01 |
PublicationDate_xml | – month: 10 year: 2019 text: 20191000 |
PublicationDecade | 2010 |
PublicationPlace | New York, USA |
PublicationPlace_xml | – name: New York, USA – name: United States – name: Cambridge |
PublicationTitle | Prehospital and disaster medicine |
PublicationTitleAlternate | Prehosp. Disaster med |
PublicationYear | 2019 |
Publisher | Cambridge University Press Jems Publishing Company, Inc |
Publisher_xml | – name: Cambridge University Press – name: Jems Publishing Company, Inc |
References | 2011; 115 2010; 75 2013; 22 2017; 2017 2013; 369 2017; 21 2009 2012; 17 2011; 15 2012; 16 2010; 81 2008; 101 2018; 22 2018; 27 2005; 23 2003; 32 2016; 33 2016; 4 2017; 53 1990; 43 2009; 10 2015; 62 1991; 44 2015; 66 2013; 31 2014; 16 2001; 38 2014; 18 2015; 90 2018; 55 2016; 49 1992; 45 S1049023X19004849_ref1 S1049023X19004849_ref34 S1049023X19004849_ref8 S1049023X19004849_ref13 S1049023X19004849_ref7 S1049023X19004849_ref35 S1049023X19004849_ref36 S1049023X19004849_ref14 S1049023X19004849_ref30 S1049023X19004849_ref4 S1049023X19004849_ref31 S1049023X19004849_ref3 Chen (S1049023X19004849_ref37) 2017; 2017 S1049023X19004849_ref32 Clark (S1049023X19004849_ref9); 2009 S1049023X19004849_ref33 S1049023X19004849_ref11 S1049023X19004849_ref5 S1049023X19004849_ref16 S1049023X19004849_ref38 S1049023X19004849_ref19 S1049023X19004849_ref23 S1049023X19004849_ref24 Bhalla (S1049023X19004849_ref18) 2012; 17 S1049023X19004849_ref25 S1049023X19004849_ref26 S1049023X19004849_ref20 S1049023X19004849_ref21 S1049023X19004849_ref22 S1049023X19004849_ref27 S1049023X19004849_ref28 S1049023X19004849_ref29 de Champlain (S1049023X19004849_ref15) 2014; 16 |
References_xml | – volume: 115 start-page: 231 issue: 2 year: 2011 end-page: 241 article-title: Assessing the diagnostic accuracy of pulse pressure variations for the prediction of fluid responsiveness: a “gray zone” approach publication-title: Anesthesiology – volume: 21 start-page: 283 issue: 3 year: 2017 end-page: 290 article-title: Causes of prehospital misinterpretations of ST elevation myocardial infarction publication-title: Prehosp Emerg Care – volume: 43 start-page: 109 issue: 1 year: 1990 end-page: 113 article-title: The clinical reality of three-zone publication-title: J Clin Epidemiol – volume: 53 start-page: 798 issue: 6 year: 2017 end-page: 804 article-title: Physician, interrupted: workflow interruptions and patient care in the emergency department publication-title: J Emerg Med – volume: 22 start-page: 419 issue: 4 year: 2018 end-page: 426 article-title: Detection of STEMI using prehospital serial 12-lead electrocardiograms publication-title: Prehosp Emerg Care – volume: 75 start-page: 174 issue: 2 year: 2010 end-page: 178 article-title: Impact of the prehospital ECG on door-to-balloon time in ST elevation myocardial infarction publication-title: Catheter Cardiovasc Interv – volume: 4 start-page: 256 issue: 13 year: 2016 article-title: Epidemiology of coronary heart disease and acute coronary syndrome publication-title: Ann Transl Med – volume: 90 start-page: 1614 issue: 12 year: 2015 end-page: 1622 article-title: Aggressive measures to decrease “door to balloon” time and incidence of unnecessary cardiac catheterization: potential risks and role of quality improvement publication-title: Mayo Clin Proc – volume: 18 start-page: 9 issue: 1 year: 2014 end-page: 14 article-title: A prospective evaluation of the utility of the prehospital 12-lead electrocardiogram to change patient management in the emergency department publication-title: Prehosp Emerg Care – volume: 2009 start-page: 117 end-page: 120 article-title: Effectiveness of electrocardiogram interpretation programs in the ambulance setting publication-title: Comput Cardiol 2009 – volume: 32 start-page: 304 issue: 2 year: 2003 end-page: 313 article-title: A grey zone for quantitative diagnostic and screening tests publication-title: Int J Epidemiol – volume: 62 start-page: 1139 issue: 11 year: 2015 end-page: 1142 article-title: The “grey zone” or how to avoid the binary constraint of decision-making publication-title: Can J Anesth Can d’anesthésie – volume: 55 start-page: 71 issue: 1 year: 2018 end-page: 77 article-title: Prehospital acute ST-elevation myocardial infarction identification in San Diego: a retrospective analysis of the effect of a new software algorithm publication-title: J Emerg Med – volume: 101 start-page: 158 issue: 2 year: 2008 end-page: 161 article-title: Effect of prehospital 12-lead electrocardiogram on activation of the cardiac catheterization laboratory and door-to-balloon time in ST-segment elevation acute myocardial infarction publication-title: Am J Cardiol – volume: 17 start-page: 121015065524007 issue: 2 year: 2012 article-title: Prehospital electrocardiographic computer identification of ST-segment elevation myocardial infarction publication-title: Prehosp Emerg Care – volume: 22 start-page: 656 issue: 8 year: 2013 end-page: 663 article-title: Interruptions in emergency department work: an observational and interview study publication-title: BMJ Qual Saf – volume: 23 start-page: 443 issue: 4 year: 2005 end-page: 448 article-title: Real-time paramedic compared with blinded physician identification of ST-segment elevation myocardial infarction: results of an observational study publication-title: Am J Emerg Med – volume: 15 start-page: 490 issue: 4 year: 2011 end-page: 498 article-title: Paramedic contact to balloon in less than 90 minutes: a successful strategy for ST-segment elevation myocardial infarction bypass to primary percutaneous coronary intervention in a Canadian emergency medical system publication-title: Prehosp Emerg Care – volume: 44 start-page: 967 issue: 9 year: 1991 end-page: 970 article-title: Diagnostic tests are not always black or white: or, all that glitters is not [a] gold [standard] publication-title: J Clin Epidemiol – volume: 38 start-page: 146 issue: 2 year: 2001 end-page: 151 article-title: Work interrupted: a comparison of workplace interruptions in emergency departments and primary care offices publication-title: Ann Emerg Med – volume: 81 start-page: e175 issue: 1 year: 2010 end-page: e212 article-title: Part 9: acute coronary syndromes publication-title: Resuscitation – volume: 45 start-page: 1035 issue: 9 year: 1992 end-page: 1039 article-title: Chance-corrected sensitivity and specificity for three-zone diagnostic tests publication-title: J Clin Epidemiol – volume: 31 start-page: 1098 issue: 7 year: 2013 end-page: 1102 article-title: An algorithm for identification of ST-elevation myocardial infarction patients by emergency medicine services publication-title: Am J Emerg Med – volume: 10 start-page: 208 issue: 4 year: 2009 end-page: 212 article-title: Factors associated with false-positive emergency medical services triage for percutaneous coronary intervention publication-title: West J Emerg Med – volume: 2017 start-page: 1910934 year: 2017 article-title: The association between door-to-balloon time of less than 60 minutes and prognosis of patients developing ST segment elevation myocardial infarction and undergoing primary percutaneous coronary intervention publication-title: Biomed Res Int – volume: 66 start-page: S6 issue: 4 year: 2015 end-page: S7 article-title: Accuracy of out-of-hospital automated ST segment elevation myocardial infarction detection by LIFEPAK 12 and 15 devices: the Los Angeles experience publication-title: Ann Emerg Med – volume: 369 start-page: 901 issue: 10 year: 2013 end-page: 909 article-title: Door-to-balloon time and mortality among patients undergoing primary PCI publication-title: N Engl J Med – volume: 49 start-page: 728 issue: 5 year: 2016 end-page: 732 article-title: Electrocardiographic diagnosis of ST segment elevation myocardial infarction: an evaluation of three automated interpretation algorithms publication-title: J Electrocardiol – volume: 16 start-page: 109 issue: 1 year: 2012 end-page: 114 article-title: Serial prehospital 12-lead electrocardiograms increase identification of ST-segment elevation myocardial infarction publication-title: Prehosp Emerg Care – volume: 44 start-page: 217 issue: 2 year: 1991 end-page: 219 article-title: Clinical reality, binary models, babies and bath water publication-title: J Clin Epidemiol – volume: 27 start-page: 655 issue: 8 year: 2018 end-page: 663 article-title: Task errors by emergency physicians are associated with interruptions, multitasking, fatigue and working memory capacity: a prospective, direct observation study publication-title: BMJ Qual Saf – volume: 16 start-page: 94 issue: 2 year: 2014 end-page: 105 article-title: Computerized interpretation of the prehospital electrocardiogram: predictive value for ST segment elevation myocardial infarction and impact on on-scene time publication-title: Can J Emerg Med – volume: 33 start-page: 471 issue: 7 year: 2016 end-page: 476 article-title: The recognition of STEMI by paramedics and the effect of computer interpretation (RESPECT): a randomized crossover feasibility study publication-title: Emerg Med J – volume: 2017 start-page: 1910934 year: 2017 ident: S1049023X19004849_ref37 publication-title: Biomed Res Int contributor: fullname: Chen – ident: S1049023X19004849_ref22 doi: 10.1016/0895-4356(91)90271-A – ident: S1049023X19004849_ref19 doi: 10.1080/10903127.2016.1247200 – ident: S1049023X19004849_ref1 doi: 10.21037/atm.2016.06.33 – ident: S1049023X19004849_ref24 doi: 10.1016/0895-4356(90)90064-V – ident: S1049023X19004849_ref4 doi: 10.1016/j.amjcard.2007.07.082 – ident: S1049023X19004849_ref28 doi: 10.1136/emermed-2015-204988 – ident: S1049023X19004849_ref34 doi: 10.1016/j.jemermed.2017.08.067 – ident: S1049023X19004849_ref20 doi: 10.1111/j.1442-2026.1998.tb00617.x – ident: S1049023X19004849_ref35 doi: 10.1067/mem.2001.115440 – ident: S1049023X19004849_ref7 doi: 10.3109/10903127.2013.825350 – ident: S1049023X19004849_ref8 doi: 10.3109/10903127.2011.598613 – ident: S1049023X19004849_ref23 doi: 10.1016/0895-4356(92)90124-6 – ident: S1049023X19004849_ref13 doi: 10.1016/j.jelectrocard.2016.04.010 – ident: S1049023X19004849_ref38 doi: 10.1016/j.mayocp.2015.08.021 – volume: 17 start-page: 121015065524007 year: 2012 ident: S1049023X19004849_ref18 publication-title: Prehosp Emerg Care contributor: fullname: Bhalla – ident: S1049023X19004849_ref5 doi: 10.1002/ccd.22257 – ident: S1049023X19004849_ref26 doi: 10.1007/s12630-015-0465-1 – ident: S1049023X19004849_ref29 doi: 10.1016/j.jemermed.2018.04.007 – ident: S1049023X19004849_ref21 doi: 10.1016/0895-4356(91)90065-H – volume: 16 start-page: 94 year: 2014 ident: S1049023X19004849_ref15 publication-title: Can J Emerg Med doi: 10.2310/8000.2013.131031 contributor: fullname: de Champlain – ident: S1049023X19004849_ref36 doi: 10.1056/NEJMoa1208200 – volume: 2009 start-page: 117 ident: S1049023X19004849_ref9 publication-title: Comput Cardiol 2009 contributor: fullname: Clark – ident: S1049023X19004849_ref11 doi: 10.1016/j.ajem.2004.10.011 – ident: S1049023X19004849_ref3 doi: 10.1016/j.resuscitation.2010.09.001 – ident: S1049023X19004849_ref33 doi: 10.1136/bmjqs-2013-001967 – ident: S1049023X19004849_ref32 doi: 10.1136/bmjqs-2017-007333 – ident: S1049023X19004849_ref31 doi: 10.1080/10903127.2017.1399185 – ident: S1049023X19004849_ref14 doi: 10.1016/j.annemergmed.2015.07.044 – ident: S1049023X19004849_ref25 doi: 10.1093/ije/dyg054 – ident: S1049023X19004849_ref30 doi: 10.3109/10903127.2011.614045 – ident: S1049023X19004849_ref16 doi: 10.1016/j.ajem.2013.04.013 – ident: S1049023X19004849_ref27 doi: 10.1097/ALN.0b013e318225b80a |
SSID | ssj0029526 |
Score | 2.2536376 |
Snippet | ST-segment elevation myocardial infarction (STEMI) is a time-sensitive entity that has been shown to benefit from prehospital diagnosis by electrocardiogram... Introduction:ST-segment elevation myocardial infarction (STEMI) is a time-sensitive entity that has been shown to benefit from prehospital diagnosis by... INTRODUCTIONST-segment elevation myocardial infarction (STEMI) is a time-sensitive entity that has been shown to benefit from prehospital diagnosis by... |
SourceID | proquest crossref pubmed cambridge |
SourceType | Aggregation Database Index Database Publisher |
StartPage | 489 |
SubjectTerms | Accuracy Algorithms Angioplasty Decision Support Techniques Electrocardiography Emergency medical care Emergency Medical Services Emergency services Fires Heart attacks Heart rate Humans Intubation Medical diagnosis Myocardial infarction Original Research Paramedics Patients Sensitivity and Specificity ST Elevation Myocardial Infarction - diagnosis ST Elevation Myocardial Infarction - physiopathology Utah |
Title | A Novel Algorithm for Improving the Diagnostic Accuracy of Prehospital ST-Elevation Myocardial Infarction |
URI | https://www.cambridge.org/core/product/identifier/S1049023X19004849/type/journal_article https://www.ncbi.nlm.nih.gov/pubmed/31507262 https://www.proquest.com/docview/2338535139 https://search.proquest.com/docview/2288716382 |
Volume | 34 |
hasFullText | 1 |
inHoldings | 1 |
isFullTextHit | |
isPrint | |
link | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwfV3daxQxEB9s-yKIaP06rUcEn8TgbXK5JE9ytleq4FG0hXs78rWtcO7W653Q_96Zzd4eUlrYhyUbsiGZyfzmIzMA78MoOe-HFNWoBB-a4LnTUXGHZ5_0AyfL2ATITkcn58NvMzVrDW7XbVjl5kxsDupYB7KRfxKoSympELB8vvrDqWoUeVfbEho7sFeQoKOb4oddiIewqim3hhqH5SibZhuvJqWMpkZqQ4GIREypNLe5Ff6XUXcAz0YAHT-Bxy1yZOO81U_hQar24VE2u7F8m-gZ_Bqzaf03YbfFBc5-dfmbISplnemAId5jRzm8Dsdh4xDWSxduWF2y02W6bKuIsJ9nfLJI2VzLvt-gwCNCWrCvVYmcQa3P4fx4cnZ4wttqCjxILVe8MDbYwoycECYkr4Rv0KJ3QSlXeHxRtojkyJSx0BKhVfAITwbJFGWZopEvYLeqq_QKmE2ujHpQBnyGHpk4ahutc6SbaGFiDz52azlveeJ6nuPJ9PzW0vfgw2a551c5x8Z9nQ82G7IdekscPXjXfUZGIe-Hq1K9xj7CkHIojejBy7yR3d8kwWIxEq_vH_wNPES8ZHMs3wHsrpbr9BYxycr3YUfPdL8hvz7sfZlMT3_8AxCI3aM |
link.rule.ids | 314,780,784,12056,12223,21388,27924,27925,31719,31720,33266,33267,33744,33745,43310,43579,43805,73745,74014,74302 |
linkProvider | ProQuest |
linkToHtml | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwfV3da9swED_W5GGFUfbZpes2DfY0JhZLUSw9jWxLSbcmhDWBvBl9eR2kdpsmg_73O1mOQxkr-MHIQjanO93vPnwH8N72vTamF7IaBaM9aQ3VqRNU49nHTVfz3FUJspP-aN77vhCL2uF2U6dVbs_E6qB2pQ0-8k8MbSnBBQKWz1fXNHSNCtHVuoXGHrRD5XTRgvaX4WT6szG5lKgarqHNoShqp8U2rhmKRofBMIYqEdk4FNPcVVe4q6X-Az0rFXTyGA5q7EgGcbOfwANfPIVH0fFG4v9Ez-D3gEzKPx6nLX_h968vLgniUtI4DwgiPvItJtjhOmRg7Wal7S0pczJd-Yu6jwg5n9Hh0keHLRnfosoLrLQkp0WOshFGn8P8ZDj7OqJ1PwVqecrXNJHKqkT2NWPSeiOYqfCi0VYInRi8ESpxIZTJXZJyBFfWIEDpepnkuXeSv4BWURb-JRDlde7Sbm7x6hkUY5cqp7QO1knKpOvAx4aWWS0VN1nMKEuzf0jfgQ9bcmdXscrGfZOPtxuyW3rHHh141zxGUQnxD134coNzmAzmIZesA4dxI5u38QCMWZ8d3b_4W3g4mo3PsrPTyY9XsI_oScXMvmNorVcb_xoRytq8qdnwL5cY37A |
linkToPdf | http://utb.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwfV3da9swED-2FMZgjH122fqhwZ7GRGMpiqWnkbUJbbeFsLWQN6Mvt4XM7tJk0P9-J0txGKMFPxhZyEa60_1O9_MdwAc78NqYfmA1Ckb70hqqcyeoxr2Pm57mpWsIspPB8Xn_dCZmif90k2iV6z2x2ahdbcMZ-QFDX0pwgYDloEy0iOnR-PP1bxoqSIVIayqn8RC20Cr2WAe2vowm0x-t-6VEU3wN_Q9F0VLN1jHOkEA6NIY2NI8o0iGx5ibTwr8W6w4Y2pij8TN4mnAkGcaFfw4PfPUCnsRDOBL_LXoJV0Myqf947Da_wO9fXv4iiFFJe5BAEP2Ro0i2w3HI0NrVQttbUpdkuvCXqaYI-XlGR3MfD2_J91s0f0Gs5uSkKlFPQusrOB-Pzg6PaaqtQC3P-ZJmUlmVyYFmTFpvBDMNdjTaCqEzgzdCZS6ENbnLco5AyxoEKz0vs7L0TvLX0Knqyr8BorwuXd4rLV59gyrtcuWU1sFTyZl0XfjUzmWRNOSmiOyyvPhv6rvwcT3dxXXMuHFf5531gmyG3ohKF963j1FtQixEV75eYR8mg6vIJevCdlzI9m08gGQ2YG_vH3wfHqEEFt9OJl_fwWMEUiqS_Hags1ys_C6ClaXZS1L4FzAh490 |
openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=A+Novel+Algorithm+for+Improving+the+Diagnostic+Accuracy+of+Prehospital+ST-Elevation+Myocardial+Infarction&rft.jtitle=Prehospital+and+disaster+medicine&rft.au=Goebel%2C+Mat&rft.au=Vaida%2C+Florin&rft.au=Kahn%2C+Christopher&rft.au=Donofrio%2C+J+Joelle&rft.date=2019-10-01&rft.eissn=1945-1938&rft.volume=34&rft.issue=5&rft.spage=489&rft_id=info:doi/10.1017%2FS1049023X19004849&rft_id=info%3Apmid%2F31507262&rft.externalDocID=31507262 |
thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1049-023X&client=summon |
thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1049-023X&client=summon |
thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1049-023X&client=summon |