title: Outcomes of non-STEMI patients transported by emergency medical services vs private vehicle.
abstract: BACKGROUND
  Non-ST-segment elevation myocardial infarctions (NSTEMIs) are more common but less studied than ST-segment elevation myocardial infarctions (STEMIs) treated by emergency medical services (EMS).
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the differences in baseline characteristics and outcomes of NSTEMI patients when arriving by EMS vs self-transport.
  
  
  METHODS
  We performed a retrospective medical record review of 96 EMS patients and 96 self-transport patients with the diagnosis of NSTEMI based on billing code.
  
  
  RESULTS
  The mean age of patients arriving by EMS was 75 vs 65 years for self-transport patients (P≤ .000). Patients arriving by self-transport received cardiac catheterization more often than patients arriving by EMS (84% vs 49%, P≤ .001). Emergency medical services patients had significantly longer average hospital length of stay and intensive care unit length of stay than did patients arriving by self-transport (6.5 vs 4 days [P≤ .001] and 4.1 vs 2.7 days [P= .019]). Significantly more EMS patients were discharged to a new extended care facility (25% vs 3.1%, P≤ .001). Finally, more EMS patients died in the hospital (18.8 vs 4.2%, P= .002).
  
  
  CONCLUSIONS
  Patients with NSTEMI who arrived by EMS are older, are more ill, and have worse outcomes compared with patients who arrived by self-transport. Further research into patient reasoning for mode of transportation to the ED may influence public health interventions, public policy development, and EMS and hospital protocols for management of NSTEMIs. The high mortality in prehospital cohort should prompt further investigation to develop evidence-based protocols.
authors.affiliation: Summa Akron City Hospital, Akron, OH; Northeast Ohio Medical University, Rootstown, OH. Electronic address: bhallam@summahealth.org.
authors.forename: Mary Colleen
authors.initials: MC
authors.lastname: Bhalla
authors.affiliation: Summa Akron City Hospital, Akron, OH. Electronic address: freyja@summahealth.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Frey
authors.affiliation: Northeast Ohio Medical University, Rootstown, OH. Electronic address: sdials@neomed.edu.
authors.forename: Sarah
authors.initials: S
authors.lastname: Dials
authors.affiliation: Northeast Ohio Medical University, Rootstown, OH. Electronic address: kbaughma@neomed.edu.
authors.forename: Kristin
authors.initials: K
authors.lastname: Baughman
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D009820:Ohio / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014187:Transportation of Patients / Q000379:methods* / Q000706:statistics & numerical data*; D014193:Trauma Centers / Q000706:statistics & numerical data