title: The availability of prior ECGs improves paramedic accuracy in recognizing ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Early and accurate identification of ST-elevation myocardial infarction (STEMI) by prehospital providers has been shown to significantly improve door to balloon times and improve patient outcomes. Previous studies have shown that paramedic accuracy in reading 12 lead ECGs can range from 86% to 94%. However, recent studies have demonstrated that accuracy diminishes for the more uncommon STEMI presentations (e.g. lateral). Unlike hospital physicians, paramedics rarely have the ability to review previous ECGs for comparison. Whether or not a prior ECG can improve paramedic accuracy is not known.
  
  
  OBJECTIVE
  The availability of prior ECGs improves paramedic accuracy in ECG interpretation.
  
  
  METHODS
  130 paramedics were given a single clinical scenario. Then they were randomly assigned 12 computerized prehospital ECGs, 6 with and 6 without an accompanying prior ECG. All ECGs were obtained from a local STEMI registry. For each ECG paramedics were asked to determine whether or not there was a STEMI and to rate their confidence in their interpretation. To determine if the old ECGs improved accuracy we used a mixed effects logistic regression model to calculate p-values between the control and intervention.
  
  
  RESULTS
  The addition of a previous ECG improved the accuracy of identifying STEMIs from 75.5% to 80.5% (p=0.015). A previous ECG also increased paramedic confidence in their interpretation (p=0.011).
  
  
  CONCLUSIONS
  The availability of previous ECGs improves paramedic accuracy and enhances their confidence in interpreting STEMIs. Further studies are needed to evaluate this impact in a clinical setting.
authors.affiliation: Indiana University School of Medicine, Department of Emergency Medicine, Division of Out of Hospital Care, 3930 Georgetown Rd, Indianapolis, IN, USA. Electronic address: dapodonn@iu.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: O'Donnell
authors.affiliation: Indiana University School of Medicine, Department of Emergency Medicine, Division of Out of Hospital Care, 3930 Georgetown Rd, Indianapolis, IN, USA; University of Wisconsin Division of Emergency Medicine, Madison, WI, USA.
authors.forename: Mike
authors.initials: M
authors.lastname: Mancera
authors.affiliation: Indiana University School of Medicine, Department of Emergency Medicine, 720 Eskanazi Ave 3rd. Floor, Indianapolis, IN, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Savory
authors.affiliation: Indianapolis Emergency Medical Services, 3930 Georgetown Rd. Indianapolis, IN, USA.
authors.forename: Shawn
authors.initials: S
authors.lastname: Christopher
authors.affiliation: Indiana University School of Medicine, Department of Emergency Medicine, 720 Eskanazi Ave 3rd. Floor, Indianapolis, IN, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Schaffer
authors.affiliation: Indiana University School of Medicine, Department of Emergency Medicine, 720 Eskanazi Ave 3rd. Floor, Indianapolis, IN, USA.
authors.forename: Steve
authors.initials: S
authors.lastname: Roumpf
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003324:Coronary Artery Disease / Q000175:diagnosis*; D004562:Electrocardiography / Q000379:methods*; D004634:Emergency Medical Technicians / Q000193:education*; D005260:Female; D006801:Humans; D007196:Indiana; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis*; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Allied Health personnel; Electrocardiography; Emergency medical services; Myocardial infarction