Sensitivity, specificity, and predictive value of cardiac symptoms assessed by emergency medical services providers in the diagnosis of acute myocardial infarction: a multi-center observational study
Objective For patients with acute myocardial infarction (AMI), symptoms assessed by emergency medical services (EMS) providers have a critical role in prehospital treatment decisions. The purpose of this study was to evaluate the diagnostic accuracy of EMS provider-assessed cardiac symptoms of AMI....
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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The Korean Society of Emergency Medicine
2018-12-01
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| Series: | Clinical and Experimental Emergency Medicine |
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| Online Access: | http://www.ceemjournal.org/upload/pdf/ceem-17-257.pdf |
| _version_ | 1797895637224652800 |
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| author | Jeong Ho Park Sung Woo Moon Tae Yun Kim Young Sun Ro Won Chul Cha Yu Jin Kim Sang Do Shin |
| author_facet | Jeong Ho Park Sung Woo Moon Tae Yun Kim Young Sun Ro Won Chul Cha Yu Jin Kim Sang Do Shin |
| author_sort | Jeong Ho Park |
| collection | DOAJ |
| description | Objective For patients with acute myocardial infarction (AMI), symptoms assessed by emergency medical services (EMS) providers have a critical role in prehospital treatment decisions. The purpose of this study was to evaluate the diagnostic accuracy of EMS provider-assessed cardiac symptoms of AMI. Methods Patients transported by EMS to 4 study hospitals from 2008 to 2012 were included. Using EMS and administrative emergency department databases, patients were stratified according to the presence of EMS-assessed cardiac symptoms and emergency department diagnosis of AMI. Cardiac symptoms were defined as chest pain, dyspnea, palpitations, and syncope. Disproportionate stratified sampling was used, and medical records of sampled patients were reviewed to identify an actual diagnosis of AMI. Using inverse probability weighting, verification bias-corrected diagnostic performance was estimated. Results Overall, 92,353 patients were enrolled in the study. Of these, 13,971 (15.1%) complained of cardiac symptoms to EMS providers. A total of 775 patients were sampled for hospital record review. The sensitivity, specificity, positive predictive value, and negative predictive value of EMS provider-assessed cardiac symptoms for the final diagnosis of AMI was 73.3% (95% confidence interval [CI], 70.8 to 75.7), 85.3% (95% CI, 85.3 to 85.4), 3.9% (95% CI, 3.6 to 4.2), and 99.7% (95% CI, 99.7 to 99.8), respectively. Conclusion We found that EMS provider-assessed cardiac symptoms had moderate sensitivity and high specificity for diagnosis of AMI. EMS policymakers can use these data to evaluate the pertinence of specific prehospital treatment of AMI. |
| first_indexed | 2024-04-10T07:29:03Z |
| format | Article |
| id | doaj.art-a60986a5efb146c182dc6841262fb8b6 |
| institution | Directory Open Access Journal |
| issn | 2383-4625 |
| language | English |
| last_indexed | 2024-04-10T07:29:03Z |
| publishDate | 2018-12-01 |
| publisher | The Korean Society of Emergency Medicine |
| record_format | Article |
| series | Clinical and Experimental Emergency Medicine |
| spelling | doaj.art-a60986a5efb146c182dc6841262fb8b62023-02-24T01:45:52ZengThe Korean Society of Emergency MedicineClinical and Experimental Emergency Medicine2383-46252018-12-015426427110.15441/ceem.17.257203Sensitivity, specificity, and predictive value of cardiac symptoms assessed by emergency medical services providers in the diagnosis of acute myocardial infarction: a multi-center observational studyJeong Ho Park0Sung Woo Moon1Tae Yun Kim2Young Sun Ro3Won Chul Cha4Yu Jin Kim5Sang Do Shin6 Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, KoreaObjective For patients with acute myocardial infarction (AMI), symptoms assessed by emergency medical services (EMS) providers have a critical role in prehospital treatment decisions. The purpose of this study was to evaluate the diagnostic accuracy of EMS provider-assessed cardiac symptoms of AMI. Methods Patients transported by EMS to 4 study hospitals from 2008 to 2012 were included. Using EMS and administrative emergency department databases, patients were stratified according to the presence of EMS-assessed cardiac symptoms and emergency department diagnosis of AMI. Cardiac symptoms were defined as chest pain, dyspnea, palpitations, and syncope. Disproportionate stratified sampling was used, and medical records of sampled patients were reviewed to identify an actual diagnosis of AMI. Using inverse probability weighting, verification bias-corrected diagnostic performance was estimated. Results Overall, 92,353 patients were enrolled in the study. Of these, 13,971 (15.1%) complained of cardiac symptoms to EMS providers. A total of 775 patients were sampled for hospital record review. The sensitivity, specificity, positive predictive value, and negative predictive value of EMS provider-assessed cardiac symptoms for the final diagnosis of AMI was 73.3% (95% confidence interval [CI], 70.8 to 75.7), 85.3% (95% CI, 85.3 to 85.4), 3.9% (95% CI, 3.6 to 4.2), and 99.7% (95% CI, 99.7 to 99.8), respectively. Conclusion We found that EMS provider-assessed cardiac symptoms had moderate sensitivity and high specificity for diagnosis of AMI. EMS policymakers can use these data to evaluate the pertinence of specific prehospital treatment of AMI.http://www.ceemjournal.org/upload/pdf/ceem-17-257.pdfmyocardial infarctionemergency medical servicessymptom assessmentsensitivity and specificitypredictive value of tests |
| spellingShingle | Jeong Ho Park Sung Woo Moon Tae Yun Kim Young Sun Ro Won Chul Cha Yu Jin Kim Sang Do Shin Sensitivity, specificity, and predictive value of cardiac symptoms assessed by emergency medical services providers in the diagnosis of acute myocardial infarction: a multi-center observational study Clinical and Experimental Emergency Medicine myocardial infarction emergency medical services symptom assessment sensitivity and specificity predictive value of tests |
| title | Sensitivity, specificity, and predictive value of cardiac symptoms assessed by emergency medical services providers in the diagnosis of acute myocardial infarction: a multi-center observational study |
| title_full | Sensitivity, specificity, and predictive value of cardiac symptoms assessed by emergency medical services providers in the diagnosis of acute myocardial infarction: a multi-center observational study |
| title_fullStr | Sensitivity, specificity, and predictive value of cardiac symptoms assessed by emergency medical services providers in the diagnosis of acute myocardial infarction: a multi-center observational study |
| title_full_unstemmed | Sensitivity, specificity, and predictive value of cardiac symptoms assessed by emergency medical services providers in the diagnosis of acute myocardial infarction: a multi-center observational study |
| title_short | Sensitivity, specificity, and predictive value of cardiac symptoms assessed by emergency medical services providers in the diagnosis of acute myocardial infarction: a multi-center observational study |
| title_sort | sensitivity specificity and predictive value of cardiac symptoms assessed by emergency medical services providers in the diagnosis of acute myocardial infarction a multi center observational study |
| topic | myocardial infarction emergency medical services symptom assessment sensitivity and specificity predictive value of tests |
| url | http://www.ceemjournal.org/upload/pdf/ceem-17-257.pdf |
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