What question did this study set out to answer?

To evaluate how varying population prevalences of ST-elevation myocardial infarction (STEMI) affect the positive predictive value (PPV) of out-of-hospital 12-lead electrocardiograms across standard sensitivity and specificity ranges.

November 28, 2007Academic Emergency MedicineOpen Access

A Bayesian Sensitivity Analysis of Out‐of‐hospital 12‐lead Electrocardiograms: Implications for Regionalization of Cardiac Care

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Why the study?

Does the prevalence of STEMI in the out-of-hospital population affect the positive predictive value of out-of-hospital 12-lead electrocardiograms?

Population

Out-of-hospital patients evaluated for ST-elevation myocardial infarction (STEMI)

Design

Other

Authors

SYScott T. YoungquistUniversity of Utah AKAmy H. KajiTorrance Memorial Medical Center ALAri M. LipskySprint (United States)

Discussion

Member takes

Implication

Low-prevalence EMS settings sharply reduce prehospital ECG PPV and raise false-positive activations; leaves open optimal STEMI activation thresholds pending prospective validation.

Key Points

To evaluate how varying population prevalences of ST-elevation myocardial infarction (STEMI) affect the positive predictive value (PPV) of out-of-hospital 12-lead electrocardiograms across standard sensitivity and specificity ranges.
Conducted a Bayesian sensitivity analysis using literature-derived parameters: sensitivities (60%–70%), specificity (98%), and two STEMI prevalence ranges (0.5%–5% and 5%–20%).
Compared simulated PPV prediction intervals against three months of prospective data from the Los Angeles County Emergency Medical Services Agency STEMI regionalization program.
In higher-prevalence populations (5%–20%), the median PPV of prehospital ECG was 83% (95% credible interval [CrI] = 53% to 97%), but dropped to a median PPV of 43% (95% CrI = 12% to 86%) in lower-prevalence settings (0.5%–5%).
Incorporating PPV prediction intervals with prospective data from the Los Angeles County Emergency Medical Services Agency yielded an overall PPV of 66%.

Structured PICO

Does the prevalence of STEMI in the out-of-hospital population affect the positive predictive value of out-of-hospital 12-lead electrocardiograms?

Population

Out-of-hospital patients evaluated for ST-elevation myocardial infarction (STEMI)

Intervention

Out-of-hospital 12-lead electrocardiogram (PHTL)

Outcome

Positive predictive value (PPV) of PHTL for STEMI

Applying out-of-hospital 12-lead ECGs to low-risk populations yields a high false-positive rate for STEMI, which has implications for regional STEMI care systems.

Cite This Study

Youngquist et al. (2007) studied this question.

synapsesocial.com/papers/6a7d4031b920b2eb497757fc https://doi.org/10.1197/j.aem.2007.07.009

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Implication

Low-prevalence EMS settings sharply reduce prehospital ECG PPV and raise false-positive activations; leaves open optimal STEMI activation thresholds pending prospective validation.

A Bayesian Sensitivity Analysis of Out‐of‐hospital 12‐lead Electrocardiograms: Implications for Regionalization of Cardiac Care

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

A Bayesian Sensitivity Analysis of Out‐of‐hospital 12‐lead Electrocardiograms: Implications for Regionalization of Cardiac Care

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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Also Consider