Optimizing an Emergency Medical Dispatch System to Improve Prehospital Diagnosis and Treatment of Acute Coronary Syndrome: Nationwide Retrospective Study in China
BackgroundAcute coronary syndrome (ACS) is the most time-sensitive acute cardiac event that requires rapid dispatching and response. The medical priority dispatch system (MPDS), one of the most extensively used types of emergency dispatch systems, is hypothesized to provide b...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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JMIR Publications
2022-11-01
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| Series: | Journal of Medical Internet Research |
| Online Access: | https://www.jmir.org/2022/11/e36929 |
| _version_ | 1827857873161420800 |
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| author | Xuejie Dong Fang Ding Shuduo Zhou Junxiong Ma Na Li Mailikezhati Maimaitiming Yawei Xu Zhigang Guo Shaobin Jia Chunjie Li Suxin Luo Huiping Bian Gesang Luobu Zuyi Yuan Hong Shi Zhi-jie Zheng Yinzi Jin Yong Huo |
| author_facet | Xuejie Dong Fang Ding Shuduo Zhou Junxiong Ma Na Li Mailikezhati Maimaitiming Yawei Xu Zhigang Guo Shaobin Jia Chunjie Li Suxin Luo Huiping Bian Gesang Luobu Zuyi Yuan Hong Shi Zhi-jie Zheng Yinzi Jin Yong Huo |
| author_sort | Xuejie Dong |
| collection | DOAJ |
| description |
BackgroundAcute coronary syndrome (ACS) is the most time-sensitive acute cardiac event that requires rapid dispatching and response. The medical priority dispatch system (MPDS), one of the most extensively used types of emergency dispatch systems, is hypothesized to provide better-quality prehospital emergency treatment. However, few studies have revealed the impact of MPDS use on the process of ACS care.
ObjectiveThis study aimed to investigate whether the use of MPDS was associated with higher prehospital diagnosis accuracy and shorter prehospital delay for patients with ACS transferred by an emergency medical service (EMS), using a national database in China.
MethodsThis retrospective analysis was based on an integrated database of China’s MPDS and hospital registry. From January 1, 2016, to December 31, 2020, EMS-treated ACS cases were divided into before MPDS and after MPDS groups in accordance with the MPDS launch time at each EMS center. The primary outcomes included diagnosis consistency between hospital admission and discharge, and prehospital delay. Multivariable logistic regression and propensity score–matching analysis were performed to compare outcomes between the 2 groups for total ACS and subtypes.
ResultsA total of 9806 ACS cases (3561 before MPDS and 6245 after MPDS) treated by 43 EMS centers were included. The overall diagnosis consistency of the after MPDS group (Cohen κ=0.918, P<.001) was higher than that of the before MPDS group (Cohen κ=0.889, P<.001). After the use of the MPDS, the call-to-EMS arrival time was shortened in the matched ACS cases (20.0 vs 16.0 min, P<.001; adjusted difference: –1.67, 95% CI –2.33 to –1.02; P<.001) and in the subtype of ST-elevation myocardial infarction (adjusted difference: –3.81, 95% CI –4.63 to –2.98, P<.001), while the EMS arrival-to-door time (20.0 vs 20.0 min, P=.31) was not significantly different in all ACS cases and subtypes.
ConclusionsThe optimized use of MPDS in China was associated with increased diagnosis consistency and a reduced call-to-EMS arrival time among EMS-treated patients with ACS. An emergency medical dispatch system should be designed specifically to fit into different prehospital modes in the EMS system on a regional basis. |
| first_indexed | 2024-03-12T12:46:35Z |
| format | Article |
| id | doaj.art-883bc961125d41c290521e465a16b024 |
| institution | Directory Open Access Journal |
| issn | 1438-8871 |
| language | English |
| last_indexed | 2024-03-12T12:46:35Z |
| publishDate | 2022-11-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | Journal of Medical Internet Research |
| spelling | doaj.art-883bc961125d41c290521e465a16b0242023-08-28T23:19:46ZengJMIR PublicationsJournal of Medical Internet Research1438-88712022-11-012411e3692910.2196/36929Optimizing an Emergency Medical Dispatch System to Improve Prehospital Diagnosis and Treatment of Acute Coronary Syndrome: Nationwide Retrospective Study in ChinaXuejie Donghttps://orcid.org/0000-0003-0575-1287Fang Dinghttps://orcid.org/0000-0002-2495-4904Shuduo Zhouhttps://orcid.org/0000-0002-5463-3116Junxiong Mahttps://orcid.org/0000-0002-0526-713XNa Lihttps://orcid.org/0000-0003-2534-5876Mailikezhati Maimaitiminghttps://orcid.org/0000-0002-6559-0211Yawei Xuhttps://orcid.org/0000-0002-3368-6518Zhigang Guohttps://orcid.org/0000-0003-0544-5626Shaobin Jiahttps://orcid.org/0000-0002-8545-1067Chunjie Lihttps://orcid.org/0000-0002-4988-6207Suxin Luohttps://orcid.org/0000-0003-4011-1146Huiping Bianhttps://orcid.org/0000-0002-0412-1542Gesang Luobuhttps://orcid.org/0000-0003-0338-556XZuyi Yuanhttps://orcid.org/0000-0002-1410-1502Hong Shihttps://orcid.org/0000-0002-0926-9183Zhi-jie Zhenghttps://orcid.org/0000-0002-0233-5010Yinzi Jinhttps://orcid.org/0000-0003-0634-3955Yong Huohttps://orcid.org/0000-0002-5407-8773 BackgroundAcute coronary syndrome (ACS) is the most time-sensitive acute cardiac event that requires rapid dispatching and response. The medical priority dispatch system (MPDS), one of the most extensively used types of emergency dispatch systems, is hypothesized to provide better-quality prehospital emergency treatment. However, few studies have revealed the impact of MPDS use on the process of ACS care. ObjectiveThis study aimed to investigate whether the use of MPDS was associated with higher prehospital diagnosis accuracy and shorter prehospital delay for patients with ACS transferred by an emergency medical service (EMS), using a national database in China. MethodsThis retrospective analysis was based on an integrated database of China’s MPDS and hospital registry. From January 1, 2016, to December 31, 2020, EMS-treated ACS cases were divided into before MPDS and after MPDS groups in accordance with the MPDS launch time at each EMS center. The primary outcomes included diagnosis consistency between hospital admission and discharge, and prehospital delay. Multivariable logistic regression and propensity score–matching analysis were performed to compare outcomes between the 2 groups for total ACS and subtypes. ResultsA total of 9806 ACS cases (3561 before MPDS and 6245 after MPDS) treated by 43 EMS centers were included. The overall diagnosis consistency of the after MPDS group (Cohen κ=0.918, P<.001) was higher than that of the before MPDS group (Cohen κ=0.889, P<.001). After the use of the MPDS, the call-to-EMS arrival time was shortened in the matched ACS cases (20.0 vs 16.0 min, P<.001; adjusted difference: –1.67, 95% CI –2.33 to –1.02; P<.001) and in the subtype of ST-elevation myocardial infarction (adjusted difference: –3.81, 95% CI –4.63 to –2.98, P<.001), while the EMS arrival-to-door time (20.0 vs 20.0 min, P=.31) was not significantly different in all ACS cases and subtypes. ConclusionsThe optimized use of MPDS in China was associated with increased diagnosis consistency and a reduced call-to-EMS arrival time among EMS-treated patients with ACS. An emergency medical dispatch system should be designed specifically to fit into different prehospital modes in the EMS system on a regional basis.https://www.jmir.org/2022/11/e36929 |
| spellingShingle | Xuejie Dong Fang Ding Shuduo Zhou Junxiong Ma Na Li Mailikezhati Maimaitiming Yawei Xu Zhigang Guo Shaobin Jia Chunjie Li Suxin Luo Huiping Bian Gesang Luobu Zuyi Yuan Hong Shi Zhi-jie Zheng Yinzi Jin Yong Huo Optimizing an Emergency Medical Dispatch System to Improve Prehospital Diagnosis and Treatment of Acute Coronary Syndrome: Nationwide Retrospective Study in China Journal of Medical Internet Research |
| title | Optimizing an Emergency Medical Dispatch System to Improve Prehospital Diagnosis and Treatment of Acute Coronary Syndrome: Nationwide Retrospective Study in China |
| title_full | Optimizing an Emergency Medical Dispatch System to Improve Prehospital Diagnosis and Treatment of Acute Coronary Syndrome: Nationwide Retrospective Study in China |
| title_fullStr | Optimizing an Emergency Medical Dispatch System to Improve Prehospital Diagnosis and Treatment of Acute Coronary Syndrome: Nationwide Retrospective Study in China |
| title_full_unstemmed | Optimizing an Emergency Medical Dispatch System to Improve Prehospital Diagnosis and Treatment of Acute Coronary Syndrome: Nationwide Retrospective Study in China |
| title_short | Optimizing an Emergency Medical Dispatch System to Improve Prehospital Diagnosis and Treatment of Acute Coronary Syndrome: Nationwide Retrospective Study in China |
| title_sort | optimizing an emergency medical dispatch system to improve prehospital diagnosis and treatment of acute coronary syndrome nationwide retrospective study in china |
| url | https://www.jmir.org/2022/11/e36929 |
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