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. 2009 Dec 21;32(12):668–675. doi: 10.1002/clc.20673

Prehospital Electrocardiograms (ECGs) Do Not Improve the Process of Emergency Department Care in Hospitals with Higher Usage of ECGs in Non–ST‐segment Elevation Myocardial Infarction Patients

Michael T Cudnik 1,✉, W Frank Peacock 2, Deborah B Diercks 3, Matthew T Roe 4, Anita Y Chen 4
PMCID: PMC6653771  PMID: 20027666

Abstract

Background

This article will describe the impact of prehospital electrocardiogram (ECG) use on emergency department (ED) processes of care for non–ST‐segment elevation myocardial infarction (NSTEMI) patients and assess the characteristics associated with prehospital ECG use.

Methods

This is a retrospective, multicenter, observational analysis of NSTEMI patients captured by the National Cardiovascular Data Registry‐Acute Coronary Treatment and Intervention Outcomes Network Registry—Get with the Guidelines (NCDR ACTION‐GWTG) in 2007. Patient and hospital data were stratified by documentation of a prehospital ECG (pECG). Hospitals were stratified into tertiles of pECG use by higher pECG (>5.6%, n 91), lower pECG (≤ 5.6%, n = 83), or no pECG (n = 100). Statistical evaluation was done via Wilcoxon rank sum and χ2 tests.

Results

There were 21 251 patients eligible for analysis. A pECG was documented in 1609 (7.6%) patients. Of 274 hospitals, 100 (36.5%) had no pECGs recorded. Median ED length of stay (LOS) was shorter at no pECG hospitals vs lower pECG hospitals (3.97 h vs 4.12 h, P < 0.05), but not higher pECG hospitals vs no pECG hospitals (3.85 h vs 3.97 h, P = not significant [NS]). A pECG was not associated with an improvement in ED performance metrics (use of aspirin, β‐blocker, any heparin) in the higher pECG hospitals vs no pECG hospitals or the lower pECG hospitals vs no pECG hospitals.

Conclusions

Use of prehospital ECG in NSTEMI patients is uncommon. In contrast to its impact on reperfusion times in ST‐segment elevation myocardial infarction (STEMI) patients, its use does not appear to be associated with an improvement in ED processes of care at the hospital level. Copyright © 2009 Wiley Periodicals, Inc.

Full Text

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References

  • 1. Brice JH, Valenzuela T, Ornato JP, et al. Optimal prehospital cardiovascular care. Prehosp Emerg Care 2001; 5: 65–72. [DOI] [PubMed] [Google Scholar]
  • 2. Patel RJ, Vilke GM, Chan TC. The prehospital electrocardiogram. J Emerg Med 2001; 21: 35–39. [DOI] [PubMed] [Google Scholar]
  • 3. Racht EM. Prehospital 12‐lead ECG. An evolving standard of care in EMS systems. Emerg Med Serv 2001; 30: 105–107. [PubMed] [Google Scholar]
  • 4. Bjorklund E, Stenestrand U, Lindback J, et al. Prehospital diagnosis and start of treatment reduces time delay and mortality in real‐life patients with STEMI. J Electrocardiol 2005; 38: 186. [DOI] [PubMed] [Google Scholar]
  • 5. Brainard AH, Raynovich W, Tandberg D, et al. The prehospital 12‐lead electrocardiogram's effect on time to initiation of reperfusion therapy: a systematic review and meta‐analysis of existing literature. Am J Emerg Med 2005; 23: 351–356. [DOI] [PubMed] [Google Scholar]
  • 6. Bradley EH, Nallamothu BK, Curtis JP, et al. Summary of evidence regarding hospital strategies to reduce door‐to‐balloon times for patients with ST‐segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Crit Pathw Cardiol 2007; 6: 91–97. [DOI] [PubMed] [Google Scholar]
  • 7. Bradley EH, Herrin J, Wang Y, et al. Strategies for reducing the door‐to‐balloon time in acute myocardial infarction. N Engl J Med 2006; 355: 2308–2320. [DOI] [PubMed] [Google Scholar]
  • 8. Brown JP, Mahmud E, Dunford JV, et al. 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. Am J Cardiol 2008; 101: 158–161. [DOI] [PubMed] [Google Scholar]
  • 9. Le May MR, So DY, Dionne R, et al. A citywide protocol for primary PCI in ST‐segment elevation myocardial infarction. N Engl J Med 2008; 358: 231–240. [DOI] [PubMed] [Google Scholar]
  • 10. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non‐ST‐elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non‐ST‐Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J Am Coll Cardiol 2007; 50: e1–e157. [DOI] [PubMed] [Google Scholar]
  • 11. Pollack CV Jr, Braunwald E. 2007 update to the ACC/AHA guidelines for the management of patients with unstable angina and non‐ST‐segment elevation myocardial infarction: implications for emergency department practice. Ann Emerg Med 2008; 51: 591–606. [DOI] [PubMed] [Google Scholar]
  • 12. Diercks DB, Kontos MC, Chen AY, et al. Utilization and impact of pre‐hospital electrocardiograms for patients with acute ST‐segment elevation myocardial infarction: data from the NCDR (National Cardiovascular Data Registry) ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry. J Am Coll Cardiol 2009; 53: 161–166. [DOI] [PubMed] [Google Scholar]
  • 13. Bjorklund E, Stenestrand U, Lindback J, et al. Prehospital diagnosis and start of treatment reduces time delay and mortality in real‐life patients with STEMI. J Electrocardiol 2005; 38(S4): 186. [DOI] [PubMed] [Google Scholar]
  • 14. Arbabi S, Jurkovich GJ, Rivara FP, et al. Patient outcomes in academic medical centers: influence of fellowship programs and in‐house on‐call attending surgeon. Arch Surg 2003; 138: 47–51. [DOI] [PubMed] [Google Scholar]
  • 15. Andaluz N, Zuccarello M. Recent trends in the treatment of cerebral aneurysms: analysis of a nationwide inpatient database. J Neurosurg 2008; 108: 1163–1169. [DOI] [PubMed] [Google Scholar]
  • 16. Nguyen NT, Zainabadi K, Mavandadi S, et al. Trends in utilization and outcomes of laparoscopic versus open appendectomy. Am J Surg 2004; 188: 813–820. [DOI] [PubMed] [Google Scholar]
  • 17. Majumdar SR, Roe MT, Peterson ED, Chen AY, Gibler WB, Armstrong PW. Better outcomes for patients treated at hospitals that participate in clinical trials. Arch Intern Med 2008; 168: 657–662. [DOI] [PubMed] [Google Scholar]
  • 18. Swor R, Hegerberg S, Hugh‐McNally A, Goldstein M, McEachin CC. Prehospital 12‐lead ECG: efficacy or effectiveness? Prehosp Emerg Care 2006; 10: 374–377. [DOI] [PubMed] [Google Scholar]
  • 19. Swor R, Hegerberg S, Hugh‐McNally A, Goldstein M, McEachin CC. Prehospital 12‐lead ECG: efficacy or effectiveness? Prehosp Emerg Care 2006; 10(3): 374–377. [DOI] [PubMed] [Google Scholar]
  • 20. Canto JG, Rogers WJ, Bowlby LJ, French WJ, Pearce DJ, Weaver WD. The prehospital electrocardiogram in acute myocardial infarction: is its full potential being realized? National Registry of Myocardial Infarction 2 Investigators. J Am Coll Cardiol 1997; 29: 498–505. [DOI] [PubMed] [Google Scholar]
  • 21. Roe MT, Parsons LS, Pollack CV Jr, et al. Quality of care by classification of myocardial infarction: treatment patterns for ST‐segment elevation vs non‐ST‐segment elevation myocardial infarction. Arch Intern Med 2005; 165: 1630–1636. [DOI] [PubMed] [Google Scholar]
  • 22. McLaughlin RE, Lee A, Clenaghan S, McGovern S, Martyn C, Bowra J. Survey of attitudes of senior emergency physicians towards the introduction of emergency department ultrasound. Emerg Med J 2005; 22: 553–555. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23. Otero R, Garcia AJ. Clinical review: new technologies —venturing out of the intensive care unit. Crit Care 2005; 9: 296–302. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24. Peterson MA, Abele J. Bedside ultrasound for difficult lumbar puncture. J Emerg Med 2005; 28: 197–200. [DOI] [PubMed] [Google Scholar]
  • 25. Aponte H, Acosta S, Rigamonti D, Sylvia B, Austin P, Samolitis T. The use of ultrasound for placement of intravenous catheters. AANA J 2007; 75: 212–216. [PubMed] [Google Scholar]

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