Paramedics’ ability to identify STEMI (ST-elevation myocardial infarction) by interpreting prehospital ECGs is inconsistent, a new study finds.
More than 470 paramedics from 30 municipal EMS agencies in northeastern Ohio completed surveys that asked them to review ECGs from 10 prehospital patients. Three ECGs showed STEMI (inferior, anterior and lateral); two were normal; and five
showed STEMI mimics, or abnormal electrical activity that can look like STEMI but has another cause. Of the respondents, 52 percent had 10 or more years of experience, 69 percent had received ECG training within the past year, and 74 percent reported they were confident in their ability to recognize STEMI.
All paramedics correctly identified the normal ECGs. Nearly all (96 percent) detected the inferior STEMI; 78 percent spotted the anterior STEMI, while half missed the lateral STEMI. Overall, only 39 percent correctly identified all three STEMI, while just 3 percent correctly identified all 10 ECGs as either STEMI or not STEMI.
There was no correlation between years of experience, recent training or confidence level and ability to interpret ECGs, according to the study, which was conducted by researchers from Summa Akron City Hospital in Akron, Ohio, and colleagues. “Given the overall low sensitivity and specificity of our paramedics’ ability to recognize a STEMI, we cannot at this time rely solely on their interpretation to activate the cardiac catheterization laboratory,” researchers concluded. Relying on paramedics to activate the cath lab could result in both missed activations and unnecessary activations, they added.
Prehospital ECG computer identification of STEMI unreliable
Also in the April–June issue of Prehospital Emergency Care, a retrospective analysis of 200 prehospital ECGs found that computer interpretation of ECGs to identify STEMI isn’t accurate enough to use as the sole source of information for cath lab activation decisions.
The analysis included 100 STEMI ECGs and 100 normal ECGs acquired using Lifepak 12 monitors and transmitted by one of 20 EMS agencies to Summa Akron City Hospital, a Level 1 trauma center. Although the computer correctly identified all 100 patients with normal ECGs, it picked up only 58 percent of STEMI. “This would have resulted in 42 missed cardiac catheterization laboratory activations, but zero inappropriate activations,” the researchers wrote. The most common incorrect interpretation of STEMI ECGs by the computer were “data quality prohibits interpretation” and “abnormal ECG unconfirmed.”
Google flu tracker tripped up this season
Google Flu Trends, which estimates the prevalence of influenza based on flu-related internet searches, got tripped up this season, vastly overestimating the actual number of cases, according to a report in the Feb. 13 issue of Nature. In previous years, Google Flu Trends closely matched official data from the Centers for Disease Control and Prevention (CDC), which is based on actual reports from thousands of hospitals nationwide. But Google Flu Trends’ estimate was twice that of the CDC’s this year.
But don’t count out the ability of social media to be used for epidemiological trend-spotting. “As flu-tracking techniques based on mining of web data and on social media proliferate, the episode is a reminder that they will complement, but not substitute for, traditional epidemiological surveillance networks,” wrote author Declan Butler. Experts told Nature it’s possible that because this year’s flu season was more severe than normal, media coverage prompted many more people to search for info about flu than actually had it.
Trauma patients, families support ‘exception from informed consent’ for research
More than 300 trauma patients and their families surveyed by researchers from the University of Pennsylvania Perelman School of Medicine expressed a “high degree of support” for the Food and Drug Administration’s Exception from Informed Consent policy. The policy was set in 1996 to allow researchers to conduct clinical trials on treatments for time-sensitive emergencies such as trauma, cardiac arrest and stroke when getting a patient’s OK may be impossible.
Specifically, researchers asked trauma patients and their families about AVERT Shock, which will investigate the effect of using the hormone vasopressin during resuscitation of patients who have lost a lot of blood. More than 95 percent support the need for more trauma research and agree that the AVERT Shock Trial is an important study to perform. About 67 percent said it would be appropriate to enroll a patient without the consent of a family member; 77 percent said they themselves would agree to be enrolled, according to the study, which is in the January issue of the Journal of Trauma and Acute Care Surgery.
U.S. drivers more distracted than European drivers
U.S. drivers aged 18 to 64 are three times more likely to say that they talked on their cell phone while driving in the past month than drivers in the United Kingdom (69 percent vs. 21 percent), according to a study using data collected in 2011 from the United States, the United Kingdom and six European nations (Belgium, France, Germany, the Netherlands, Portugal and Spain). About 31 percent of U.S. drivers reported reading or sending texts or e-mails while driving, higher than all other nations except for Portugal, also at 31 percent. On the low end was Spain: 15 percent of drivers admitted texting. The rest of the European nations fell somewhere in between.
U.S. men and women aged 25 to 44 years were more likely to talk on a cell phone while driving than those aged 55 to 64, while those aged 18 to 34 years were more likely to text or e-mail than older groups. The research is in the Centers for Disease Control and Prevention’s March 15 Morbidity and Mortality Weekly Report.
