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Physician Attitudes About Prehospital 12-Lead ECGs in Chest Pain Patients

Published online by Cambridge University Press:  28 June 2012

Andrew H. Brainard ,
Philip Froman ,
Maria E. Alarcon ,
Bill Raynovich  and
Dan Tandberg
Andrew H. Brainard
Affiliation:
EMS Academy, University of New Mexico, Albuquerque, New Mexico
Philip Froman
Affiliation:
Medical Director, Albuquerque Ambulance Service, and Departmet of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
Maria E. Alarcon
Affiliation:
Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
Bill Raynovich*
Affiliation:
EMS Academy, University of New Mexico, Albuquerque, New Mexico
Dan Tandberg
Affiliation:
Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
*
EMS Academy, 2700 Yale Boulevard SE, Albuquerque, New Mexico 87106, USA E-mail: [email protected]
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Abstract

Introduction:

The prehospital 12-lead electrocardiogram (ECG) has become a standard of care. For the prehospital 12-lead ECG to be useful clinically, however, cardiologists and emergency physicians (EP) must view the test as useful. This study measured physician attitudes about the prehospital 12-lead ECG.

Hypothesis:

This study tested the hypothesis that physicians had “no opinion” regarding the prehospital 12-lead ECG.

Methods:

An anonymous survey was conducted to measure EP and cardiologist attitudes toward prehospital 12-lead ECGs. Hypothesis tests against “no opinion” (VAS = 50 mm) were made with 95% confidence intervals (CIs), and intergroup comparisons were made with the Student-t-test.

Results:

Seventy-one of 87 (81.6%) surveys were returned. Twenty-five (67.6%) cardiologists responded and 45 (90%) EPs responded. Both groups of physicians viewed prehospital 12-lead ECGs as beneficial (mean = 69 mm; 95% CI = 65–74mm). All physicians perceived that ECGs positively influence preparation of staff (mean = 63 mm; 95% CI = 60–72mm) and that ECGs transmitted to hospitals would be beneficial (mean = 66 mm; 95% CI = 60–72mm). Cardiologists had more favorable opinions than did EPs. The ability of paramedics to interpret ECGs was not seen as important (mean = 50 mm; 95% CI = 43–56mm). The justifiable increase in field time was perceived to be 3.2 minutes (95% CI = 2.7–3.8 minutes), with 23 (32.8%) preferring that it be done on scene, 46 (65.7%) during transport, and one (1.4%) not at all.

Conclusions:

Prehospital 12-lead ECGs generally are perceived as worthwhile by cardiologists and EPs. Cardiologists have a higher opinion of the value and utility of field ECGs. Since the reduction in mortality from the 12-lead ECG is small, it is likely that positive physician attitudes are attributable to other factors.

Keywords

12-lead ECGadvance cardiac life supportacute myocardial infarctioncardiologyelectrocardiogramemergencyemergency physicianemergency medical servicesprehospitalreperfusionstandard of caresurvey
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 17 , Issue 1 , March 2002 , pp. 33 - 37
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2002

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References

1. The American Heart Association in Collaboration with the International Liaison Committee on Resuscitation: Guidelines 2000 for cardiopulmonary resuscitation and emergency cardiovascular care. Part 6: Advanced cardiovascular life support: 7C: A guide to the International ACLS algorithms. Circulation. 2000; 102(8 Suppl): I142–157.Google Scholar
2. Aufderheide, TP, Bossaert, LL, Field, J, Herlitz, J, Leizorovicz, A, Littrell, KA, Ornato, JP, Peberdy, MA, Ribichini, F: Acute coronary syndromes. Ann Emerg Med 2001; 37: S163–181.CrossRefGoogle ScholarPubMed
3. Joyce, SM: Prehospital 12-lead ECG. Ann Emerg Med 1997; 30(3): 352–353.Google Scholar
4. Canto, JG, Rogers, WJ, Bowlby, LJ, French, WJ, Pearce, DJ, Weaver, WD: The prehospital electrocardiogram in acute myocardial infarction: Is its full potential being realized? National Registry of Myocardial Infarction 2 Investigators. J Am Col Cardiol 1997; 29(3): 498–505.Google Scholar
5. Todd, KH, Fun, LJP: The minimum clinically important difference in physician-assigned visual analog pain scores. Acad Emerg Med 1996; 3: 142–146.CrossRefGoogle ScholarPubMed
6. Bond, A, Lader, M: The use of analogue scales in rating subjective feelings. Br J Med Psychol 1974; 47: 211–218.Google Scholar
7. The American Heart Association in collaboration with the International Liaison Committee on Resuscitation: Part 1: Introduction to the international guidelines 2000 for CPR and ECC: A consensus on science. Circulation 2000; 102(8 Suppl): 1–11.Google Scholar
8. Brown, SG, Galloway, DM: Effect of ambulance 12-lead ECG recording on times to hospital reperfusion in acute myocardial infarction. Med J Aust 2000; 172(2): 81–84.Google Scholar
9. Weaver, WD, Cerqueira, M, Hallstrom, AP, Litwin, PE, Martin, JS, Kudenchuk, PJ, Eisenberg, M: Prehospital-initiated vs hospital-initiated thrombolytic therapy. The Myocardial Infarction Triage and Intervention Trial. JAMA 1993; 270(10): 1211–1216.Google Scholar
10. Foster, DB, Dufendach, JH, Barkdoll, CM, Mitchell, BK: Prehospital recognition of AMI using independent nurse/paramedic 12-lead ECG evaluation: Impact on in-hospital times to thrombolysis in a rural community hospital. Am J Emerg Med 1994; 12(1): 25–31.CrossRefGoogle Scholar
11. Karagounis, L, Ipsen, SK, Jessop, MR, Gilmore, KM, Valenti, DA, Clawson, JJ, Teichman, S, Anderson, JL: Impact of field-transmitted electrocardiography on time to in-hospital thrombolytic therapy in acute myocardial infarction. Am J Cardiol 1990; 66(10): 786–791.Google Scholar
12. Kereiakes, DJ, Gibler, WB, Martin, LH, Pieper, KS, Anderson, LC: Relative importance of emergency medical system transport and the prehospital electrocardiogram on reducing hospital time delay to therapy for acute myocar-dial infarction: a preliminary report from the Cincinnati Heart Project. Am Heart J 1992; 123(4 Pt 1): 835–840.Google Scholar
13. Aufderheide, TP, Lawrence, SW, Hall, KN, Otto, LA: Pre-hospital 12-lead electrocardiograms reduce hospital-based time to treatment in thrombolytic candidates. Acad Emerg Med 1994; 1(2): A13–14.Google Scholar
14. Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group: Indications for fibrinolytic therapy in suspected acute myocardial infarction: Collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet 1994; 343(8893): 311–322.Google Scholar
15. Boersma, E, Maas, AC, Deckers, JW, Simoons, ML: Early thrombolytic treatment in acute myocardial infarction: Reappraisal of the golden hour. Lancet 1996; 348(9030): 771–775.CrossRefGoogle ScholarPubMed
16. The American Heart Association in collaboration with the International Liaison Committee on Resuscitation: Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 7: The era of reperfusion. Circulation 2000; 102(8) Suppl 1: 1–184.Google Scholar
17. Brown, AL, Mann, NC, Daya, M, Goldberg, R, Meischke, H, Taylor, J, Smith, K, Osganian, S, Cooper, L: Demographic, belief, and situational factors influencing the decision to utilize emergency medical services among chest pain patients. Rapid Early Action for Coronary Treatment (REACT) study. Circulation. 2000; 102(2): 173–178.Google Scholar
18. Seipmann, DB, Mann, NC, Hedges, JR: Association between prepayment systems and emergency medical services use among patients with acute chest discomfort syndrome. Ann Emerg Med 2000; 35(6): 573–577.CrossRefGoogle Scholar
19. Chen, J, Radford, MJ, Wang, Y, Marciniak, TA, Krumholz, HM: Do “America's Best Hospitals” perform better for acute myocardial infarction? N Engl J Med 1999; 340(4): 286–292.CrossRefGoogle Scholar