Association of Symptoms and Mode of Transportation to Emergency Department in Patients With Acute Coronary Syndrome.
Leslie L Davis, Thomas P McCoy, Barbara Riegel and 3 others
PMID 36720034WHAT IT FOUND
Only 44% of 278 ACS patients used EMS.
Symptom clusters beyond chest pain were linked to higher odds of EMS use, but clusters were not linked to delay; EMS arrival was linked to 68.5 minutes less delay.
Key findings
01Only 121 of 278 ACS patients (44%) arrived by EMS, while 157 (56%) used private or other non-EMS transportation.
02Compared with Classic ACS symptoms alone, Classic ACS plus Pain symptoms (AOR = 2.66), Classic ACS plus Stress symptoms (AOR = 2.61), all three clusters (AOR = 3.90), and Stress symptoms alone (AOR = 3.12) were associated with higher odds of EMS use.
03After adjustment, symptom clusters were not significantly associated with median prehospital delay (p = 0.952), while EMS arrival was associated with a median delay 68.5 minutes shorter than non-EMS arrival (p = 0.002).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Symptoms and symptom onset time were reported after the ACS event, not observed in real time. The study did not collect symptom duration, frequency, or severity. The study did not collect reasons for transportation choice, such as knowledge, perceived speed, cost, geography, bystanders, or fear. Only 278 of 331 ACS patients had documented mode of transportation, and delay time was available for 260. The analysis came from patients with a history of or at risk for ischemic heart disease, so it may not apply to people without that history. The authors call for more research in a larger and more diverse population.
The easy way to misread this
Do not read the 68.5 minutes shorter delay as proof that calling EMS caused a shorter delay. This was an observational secondary analysis of trial data, and symptom clusters were not significantly associated with delay time.