title: A prospective evaluation of the utility of the prehospital 12-lead electrocardiogram to change patient management in the emergency department.
abstract: OBJECTIVE
  Retrospective research has shown that 19% of 12-lead prehospital electrocardiograms (prehospital ECGs) had clinically significant abnormalities that were not captured on the initial emergency department (ED) ECG and had the potential to change medical management. The purpose of this study was to prospectively determine how many prehospital ECGs had clinically significant abnormalities not present on the initial ED ECG and determine how many prehospital ECGs changed physician management.
  
  
  METHODS
  We conducted a 3-month, prospective cohort study of patients who had a 12-lead prehospital ECG completed by EMS prior to arriving at one of two tertiary care EDs. STEMI bypass patients were excluded. Physicians reviewed the prehospital ECG to determine whether there were any clinically significant abnormalities present on the prehospital ECG not captured on the initial ED ECG. Physicians recorded if and how the prehospital ECG changed their management.
  
  
  RESULTS
  A total of 281 patients were enrolled. Thirty-five (12.5%; 95% CI: 9.1%, 16.8%) prehospital ECGs showed changes that were not captured on the initial ED ECG (11 ST depression, 5 T-wave inversion [TWI], 2 ST depression and TWI, 12 arrhythmia, 2 arrhythmia with ST depression, 2 ST elevation, 1 unknown). Fifty-two (18.5%; 95% CI: 14.4%, 23.5%) prehospital ECGs influenced physician management. There were 30 (10.7%) instances where physicians were willing to refer the patient to an inpatient service based on information captured on the prehospital ECG, regardless if the initial ED ECG was normal.
  
  
  CONCLUSIONS
  Prehospital ECGs show clinically significant abnormalities that are not always captured on the initial ED ECG. Prehospital ECGs have the potential to change the management of patients in the ED.
authors.affiliation: From the Division of Emergency Medicine, Department of Medicine, The University of Western Ontario (MD, ML, SM, AD) , London, Ontario , Canada ; and the Southwest Ontario Regional Base Hospital Program (MD, ML, AD) , London, Ontario , Canada .
authors.forename: Matthew
authors.initials: M
authors.lastname: Davis
authors.forename: Michael
authors.initials: M
authors.lastname: Lewell
authors.forename: Shelley
authors.initials: S
authors.lastname: McLeod
authors.forename: Adam
authors.initials: A
authors.lastname: Dukelow
mesh_terms: D003657:Decision Making; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods*; D006331:Heart Diseases / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D009864:Ontario; D011446:Prospective Studies