Sensitivity, specificity, and predictive value of cardiac symptoms assessed by emergency medical services providers in the diagnosis of acute myocardial infarction: a multi-center observational study
- Authors
- Park, Jeong Ho; Moon, Sung Woo; Kim, Tae Yun; Ro, Young Sun; Cha, Won Chul; Kim, Yu Jin; Shin, Sang Do
- Issue Date
- Dec-2018
- Publisher
- SEOUL KOREAN SOC EMERGENCY MEDICINE
- Keywords
- Predictive value of tests; Myocardial infarction; Emergency medical services; Symptom assessment; Sensitivity and specificity
- Citation
- CLINICAL AND EXPERIMENTAL EMERGENCY MEDICINE, v.5, no.4, pp.264 - 271
- Indexed
- SCOPUS
KCI
- Journal Title
- CLINICAL AND EXPERIMENTAL EMERGENCY MEDICINE
- Volume
- 5
- Number
- 4
- Start Page
- 264
- End Page
- 271
- URI
- https://scholar.korea.ac.kr/handle/2021.sw.korea/71403
- DOI
- 10.15441/ceem.17.257
- ISSN
- 2383-4625
- Abstract
- Objective For patients with acute myocardial infarction (AMI), symptoms assessed by emergency medical services (EMS) providers have a critical role in prehospital treatment decisions. The purpose of this study was to evaluate the diagnostic accuracy of EMS provider-assessed cardiac symptoms of AMI. Methods Patients transported by EMS to 4 study hospitals from 2008 to 2012 were included. Using EMS and administrative emergency department databases, patients were stratified according to the presence of EMS-assessed cardiac symptoms and emergency department diagnosis of AMI. Cardiac symptoms were defined as chest pain, dyspnea, palpitations, and syncope. Disproportionate stratified sampling was used, and medical records of sampled patients were reviewed to identify an actual diagnosis of AMI. Using inverse probability weighting, verification bias-corrected diagnostic performance was estimated. Result Overall, 92,353 patients were enrolled in the study. Of these, 13,971 (15.1%) complained of cardiac symptoms to EMS providers. A total of 775 patients were sampled for hospital record review. The sensitivity, specificity, positive predictive value, and negative predictive value of EMS provider-assessed cardiac symptoms for the final diagnosis of AMI was 73.3% (95% confidence interval [CI], 70.8 to 75.7), 85.3% (95% CI, 85.3 to 85.4), 3.9% (95% CI, 3.6 to 4.2), and 99.7% (95% CI, 99.7 to 99.8), respectively. Conclusion We found that EMS provider-assessed cardiac symptoms had moderate sensitivity and high specificity for diagnosis of AMI. EMS policymakers can use these data to evaluate the pertinence of specific prehospital treatment of AMI.
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Collections - College of Medicine > Department of Medical Science > 1. Journal Articles
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