Lack of Significant Coronary History and ECG Misinterpretation Are the Strongest Predictors of Undertriage in Prehospital Chest Pain.
Ziad Faramand, Stephanie O Frisch, Amber DeSantis and 4 others
PMID 30558822WHAT IT FOUND
About 30% of acute MI cases were triaged low risk by EMS, especially when patients had no prior coronary revascularization or ECG changes were misread.
ED nurses should reassess chest pain and ECG regardless of field triage.
Key findings
01About 30% of confirmed acute MI events were undertriaged by EMS as low risk.
02Lack of prior coronary revascularization and inaccurate prehospital ECG interpretation were predictors of undertriage among MI patients.
03EMS triage had 70% sensitivity, 97% specificity, 14% positive predictive value, and 86% negative predictive value for acute MI.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used only patients transported by EMS to hospitals with PCI capabilities, so the findings may not apply to other systems. Confirmed MI rate was low at 7.5%, which can make positive predictive value poor. Nontransmitted prehospital ECGs were not permanently stored, so some comparisons relied on ED ECGs and possible resolution of ischemic changes before arrival. EMS provider training and use of computer-assisted ECG interpretation were unknown, and failed ECG transmissions could not be quantified.
The easy way to misread this
Do not read a low-risk EMS triage as excluding acute MI. Undertriage occurred, and field ECG interpretation was often inaccurate.