Development and validation of a prioritization rule for obtaining an immediate 12-lead electrocardiogram in the emergency department to identify ST-elevation myocardial infarction

Glickman, Seth W.; Shofer, Frances S.; Wu, Michael C.; Scholer, Matthew J.; Ndubuizu, Adanma; Peterson, Eric D.; Granger, Christopher B.; Cairns, Charles B.; Glickman, Lawrence T.

doi:10.1016/j.ahj.2011.10.021

Cited by 40 publications

(35 citation statements)

References 22 publications

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“…15,21,22 The American College of Cardiology, The American Heart Association, and The European Society of Cardiology recommend that all patients who present to the ED with chest pain have a 12-lead ECG recorded within 10 minutes of arrival. 23–26 This recommendation is based on the premise that longer delays are associated with worse outcomes, and ST-segment pattern recognition shortens the delay between the first medical contact and life-saving reperfusion therapies. 15,23,27 …”

Section: Ischemia Monitoring In the Emergency Departmentmentioning

confidence: 99%

Cardiac Monitoring in the Emergency Department

Zègre‐Hemsey

Garvey

Carey

2016

Critical Care Nursing Clinics of North America

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Section: Ischemia Monitoring In the Emergency Departmentmentioning

confidence: 99%

Cardiac Monitoring in the Emergency Department

Zègre‐Hemsey

Garvey

Carey

2016

Critical Care Nursing Clinics of North America

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“…We categorized patients presenting with both "chest pain" and non-chest pain symptoms into "chest pain". In the absence of "chest pain", we prioritized the symptoms suggestive of STEMI and that are included in the Glickman rule: chest pain (in age ≥30 years); weakness, syncope, dyspnea, altered mental change, or upper extremity pain (in age ≥50 years); and abdominal pain or nausea/vomiting (in age ≥80 years) 5. Lastly, all patients were divided into a chest pain group and a non-chest pain group.…”

Section: Methodsmentioning

confidence: 99%

“…Such patients may complain of symptoms such as dyspnea, weakness, syncope, mental change, and nausea/vomiting 5,6,7. These patients often are delayed in receiving 12-lead electrocardiogram (ECG).…”

Section: Introductionmentioning

confidence: 99%

Performance of Reperfusion Therapy and Hospital Mortality in ST-Elevation Myocardial Infarction Patients with Non-Chest Pain Complaints

Shin

Kim

et al. 2014

Yonsei Med J

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PurposeST-elevation myocardial infarction (STEMI) patients may visit the emergency department (ED) complaining of sensations of pain other than the chest. We investigated our performance of reperfusion therapy for STEMI patients presenting with non-chest pains.Materials and MethodsThis was a retrospective observational cohort study. STEMI patients who underwent primary percutaneous coronary intervention (PCI) were divided into a chest pain group and a non-chest pain group. Clinical differences between the two groups and the influence of presenting with non-chest pains on door-to-electrocardiograms (ECG) time, door-to-balloon time, and hospital mortality were evaluated.ResultsOf the 513 patients diagnosed with STEMI, 93 patients presented with non-chest pains. Patients in the non-chest pain group were older, more often female, and had a longer symptom onset to ED arrival time and higher Killip class than patients in the chest pain group. There was a statistically significant delay in door-to-ECG time (median, 2.0 min vs. 5.0 min; p<0.001) and door-to-balloon time (median, 57.5 min vs. 65.0 min; p<0.001) in patients without chest pain. In multivariate analysis, presenting with non-chest pains was an independent predictor for hospital mortality (odds ratio, 2.3; 95% confidence interval, 1.1-4.7). However, door-to-ECG time and door-to-balloon time were not factors related to hospital mortality.ConclusionSTEMI patients presenting without chest pain showed higher baseline risk and hospital mortality than patients presenting with chest pain. ECG acquisition and primary PCI was delayed for patients presenting with non-chest pains, but not influencing hospital mortality. Efforts to reduce pre-hospital time delay for these patients are necessary.

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“…Although EKGs in the prehospital setting are now broadly used, protocols which recognize that the majority of older adults with ST-elevation myocardial infarction do not have chest pain have not been broadly implemented. [37] Prehospital stroke protocols have been developed and validated and have the potential to accelerate access to thrombolytic therapy. [38] However, the public health impact of these protocols is limited by the controversial benefit to risk ratio of thrombolytics for stroke in any age groups and specifically in geriatric stroke patients.…”

Section: Prehospital Geriatric Care Opportunitiesmentioning

confidence: 99%

Evolving Prehospital, Emergency Department, and “Inpatient” Management Models for Geriatric Emergencies

Carpenter

Platts‐Mills

2013

Clinics in Geriatric Medicine

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Alternative management methods are essential to ensure high quality and efficient emergency care for the growing number of geriatric adults worldwide. Protocols for case-finding and rapid diagnosis to support early condition-specific treatment for older adults with acute severe illness and injury are needed. Improved emergency department care for older adults will require providers to look beyond the diagnosis to address the influence of other factors on the patient's health: isolation and depression; finances and transportation; and chronic medical conditions and polypharmacy. This review article describes recent and ongoing efforts to enhance the quality of emergency care for older adults using alternative management approaches spanning the spectrum from prehospital care, through the emergency department, and into evolving inpatient or outpatient processes of care.

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Development and validation of a prioritization rule for obtaining an immediate 12-lead electrocardiogram in the emergency department to identify ST-elevation myocardial infarction

Cited by 40 publications

References 22 publications

Cardiac Monitoring in the Emergency Department

Cardiac Monitoring in the Emergency Department

Performance of Reperfusion Therapy and Hospital Mortality in ST-Elevation Myocardial Infarction Patients with Non-Chest Pain Complaints

Evolving Prehospital, Emergency Department, and “Inpatient” Management Models for Geriatric Emergencies

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