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      Characteristics of Prehospital Electrocardiogram Use in North Carolina Using a Novel Linkage of Emergency Medical Services and Emergency Department Data

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          Abstract

          Objective:

          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.

          Methods:

          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 2010–2014 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.

          Results:

          During 2010–2014, 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.

          Conclusions:

          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.

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          Author and article information

          Contributors
          Journal
          9703530
          21039
          Prehosp Emerg Care
          Prehosp Emerg Care
          Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
          1090-3127
          1545-0066
          27 March 2019
          17 April 2019
          Nov-Dec 2019
          01 November 2020
          : 23
          : 6
          : 772-779
          Affiliations
          University of North Carolina at Chapel Hill, School of Nursing, jzhemsey@ 123456email.unc.edu , 919-966-5490 (office), 919-966-7298 (fax)
          University of North Carolina at Chapel Hill
          University of North Carolina at Chapel Hill and EMS Performance Improvement Center
          University of North Carolina at Chapel Hill, Department of Emergency Medicine
          Article
          PMC6751030 PMC6751030 6751030 nihpa1019942
          10.1080/10903127.2019.1597230
          6751030
          30885071
          cdc06f74-7b6e-497d-afcc-c6cbc03848b0
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