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.
- Author:
Jeong Ho PARK
1
;
Sung Woo MOON
;
Tae Yun KIM
;
Young Sun RO
;
Won Chul CHA
;
Yu Jin KIM
;
Sang Do SHIN
Author Information
- Publication Type:Multicenter Study ; Original Article
- Keywords: Myocardial infarction; Emergency medical services; Symptom assessment; Sensitivity and specificity; Predictive value of tests
- MeSH: Chest Pain; Diagnosis*; Dyspnea; Emergencies*; Emergency Medical Services*; Emergency Service, Hospital; Hospital Records; Humans; Medical Records; Myocardial Infarction*; Observational Study*; Predictive Value of Tests; Sensitivity and Specificity*; Symptom Assessment; Syncope
- From: Clinical and Experimental Emergency Medicine 2018;5(4):264-271
- CountryRepublic of Korea
- Language:English
- Abstract: 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.
