Abstract 14637: Patients With Atypical Presenting Complaints of Acute Coronary Syndrome Receive Less 12-Lead Prehospital Electrocardiography in North Carolina
Introduction: Variation in use of prehospital electrocardiography (PH ECG) has been reported (between 20-80%) for patients with chest pain, but little is known about PH ECG use in patients transported by ambulance with atypical presenting complaints of acute coronary syndrome (ACS). The aims of this study were to 1) quantify the presence of atypical presenting complaints, and 2) determine PH ECG use and predictors of use among ACS patients transported by ambulance to the emergency department.
Hypothesis: We hypothesized that differences in PH ECG use would be identified among patients with typical and atypical presenting complaints.
Method: Linked prehospital and emergency department patient care data were obtained from the North Carolina Prehospital Medical Information System and the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (2010-2014). Patients >21 years old, who activated 911 with chest pain and/or anginal equivalent symptoms were included. Analysis included the calculation of descriptive statistics, adjusted odds ratios (OR), and 95% confidence intervals (CI).
Results: A total of 1,970,215 patients (mean age 56.92±22.17, 43.2% male, 63.6% White) with presenting complaints were included. Among these, 402,783 (20.4%) had atypical presenting complaints. Of patients with an atypical presenting complaint, 78,802 (19.6%) received PH ECG compared to 129,348 (68.2%) of patients with a typical presenting complaint (p<0.0001). The strongest predictor of PH ECG acquisition was presenting complaint adjusting for age, sex, race, ethnicity, insurance coverage, and ACS diagnosis. Patients with an atypical presenting complaint were significantly less likely to get an ECG, relative to those with a presenting complaint of chest pain/discomfort (odds ratio: 0.081, 95% CI: 0.080-0.082).
Conclusion: Patients with atypical presenting complaints receive less PH ECG compared to those with typical chest pain presentations; therefore, they may miss the opportunity for early triage and risk stratification with ECG in the field. Emergency care providers and patients should receive ongoing education of the differing symptom presentations in ACS in an effort to reduce delay and time to treatment.
Author Disclosures: J.K. Zegre-Hemsey: None. A.R. Fernandez,: None. K.G. Roos: None. J. Asafu-Adjei: None. J.H. Brice: None.
- © 2016 by American Heart Association, Inc.