Field triage in the ambulance versus referral via non-percutaneous coronary intervention centre in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention: A systematic review.
OBJECTIVE
The purpose of this study was to determine whether direct ambulance transport of ST-elevation myocardial infarction (STEMI) patients to a percutaneous coronary intervention (PCI) hospital (field triage) leads to a lower 30-day mortality compared to transport via a referral non-PCI hospital (referral via a spoke centre) in STEMI patients.


RESULTS
We performed a systematic review of interventions. An experienced librarian searched in PubMed, EMBASE.com and The Cochrane Library (via Wiley) from January 1980-February 2013. Studies that examined field triage and/or referral via a spoke centre in STEMI patients treated with primary or facilitated PCI were included. Two authors independently conducted the study selection and data extraction. Multivariable frequency weighted logistic regression analysis was performed to assess the effect of the type of transfer on the outcome measures. We identified 14 randomised clinical trials (RCTs), including 20 transfer groups and 4474 participants. Thirty-day mortality was lower in patients who underwent field triage (3.0%; 95% confidence interval (CI) 2.2-4.2) compared to patients who were referred via a spoke centre (4.7%; 95% CI 4.0-5.5). In multivariable frequency weighted logistic regression analysis, field triage was independently associated with a lower incidence of 30-day mortality (odds ratio (OR): 0.58; 95% CI 0.37-0.89).


CONCLUSIONS
Field triage compared to referral via a spoke centre leads to a lower 30-day mortality in STEMI patients. Therefore, direct ambulance transport to a PCI hospital should become the transfer type for STEMI patients.
1 Diagram, Zwolle, the Netherlands.
Sonja
S
Postma
1 Diagram, Zwolle, the Netherlands.
Evelien
E
Kolkman
2 Department of Health Sciences, VU Amsterdam, Amsterdam, the Netherlands.
Sidney M
SM
Rubinstein
3 Medical Library, VU University, Amsterdam, the Netherlands.
Elise P
EP
Jansma
4 Division of Cardiology, Eastern Piedmont University, Novara, Italy.
Giuseppe
G
De Luca
1 Diagram, Zwolle, the Netherlands.|5 Radboudumc, Nijmegen, the Netherlands.
Harry
H
Suryapranata
6 Department of Cardiology, Isala Hospital, Zwolle, the Netherlands.
Arnoud Wj
AW
van 't Hof
D000552:Ambulances; D004632:Emergency Medical Services; D006801:Humans; D010360:Patient Transfer / Q000458:organization & administration*; D062645:Percutaneous Coronary Intervention; D012017:Referral and Consultation; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis* / Q000601:surgery; D014218:Triage / Q000458:organization & administration*
ST-elevation myocardial infarction; Systematic review; field triage; outcome