title: The utility of the prehospital electrocardiogram.
abstract: OBJECTIVE
  The 12-lead electrocardiogram (ECG) can capture valuable information in the prehospital setting. By the time patients are assessed by an emergency department (ED) physician, their symptoms and any ECG changes may have resolved. We sought to determine whether the prehospital electrocardiogram (pECG) could influence ED management and how often the pECG was available to and reviewed by the ED physician.
  
  
  METHODS
  A retrospective medical record review was conducted on a random sample of patients ≥ 18 years who had a prehospital 12-lead ECG and were transported to one of two tertiary care centres. Data were recorded onto a standardized data extraction tool. Three investigators independently compared the pECG to the first ECG obtained in the ED after patient arrival at the hospital. Any abnormalities not present on the ED ECG were adjudicated to ascertain whether they had the potential to change ED management.
  
  
  RESULTS
  Of 115 ambulance runs selected, 47 had no pECG attached to the ambulance call record (ACR) and another 5 were excluded (one ST elevation myocardial infarction, one cardiac arrest, three ACR missing). Of the 63 pECGs reviewed, 16 (25%) showed changes not apparent on the initial ED ECG (κ  =  0.83; 95% CI 0.74-0.93), of which 12 had differences that might influence ED management (κ  =  0.76; 95% CI 0.72-0.82). Only one hospital record contained a copy of the pECG, despite the current protocol that paramedics print two copies of the pECG on arrival in the ED (one copy for the ACR and one to be handed to the medical personnel). None of 110 ED charts documented that the pECG was reviewed by the ED physician.
  
  
  CONCLUSIONS
  The pECG has the potential to influence ED management. Improvement in paramedic and physician documentation and a formal pECG handover process appear necessary.
authors.affiliation: Division of Emergency Medicine, Department of Medicine, The University of Western Ontario, London, ON.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Davis
authors.forename: Adam
authors.initials: A
authors.lastname: Dukelow
authors.forename: Shelley
authors.initials: S
authors.lastname: McLeod
authors.forename: Severo
authors.initials: S
authors.lastname: Rodriguez
authors.forename: Michael
authors.initials: M
authors.lastname: Lewell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D003266:Continuity of Patient Care; D004562:Electrocardiography; D004634:Emergency Medical Technicians; D005260:Female; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008875:Middle Aged; D009864:Ontario; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies