Emergency department screening for early ECG in STEMI patients showed an overall missed case rate of 12.8% across 7 institutions, with performance varying widely from 3.4% to 32.6%.
Observational
Yes
Significant variability exists in emergency department STEMI screening performance, with missed case rates ranging from 3.4% to 32.6%, indicating substantial room for process improvement to ensure timely ECG acquisition.
Background Timely diagnosis of ST ‐segment elevation myocardial infarction ( STEMI ) in the emergency department ( ED ) is made solely by ECG . Obtaining this test within 10 minutes of ED arrival is critical to achieving the best outcomes. We investigated variability in the timely identification of STEMI across institutions and whether performance variation was associated with the ED characteristics, the comprehensiveness of screening criteria, and the STEMI screening processes. Methods and Results We examined STEMI screening performance in 7 ED s, with the missed case rate ( MCR ) as our primary end point. The MCR is the proportion of primarily screened ED patients diagnosed with STEMI who did not receive an ECG within 15 minutes of ED arrival. STEMI was defined by hospital discharge diagnosis. Relationships between the MCR and ED characteristics, screening criteria, and STEMI screening processes were assessed, along with differences in door‐to‐ ECG times for captured versus missed patients. The overall MCR for all 7 ED s was 12.8%. The lowest and highest MCR s were 3.4% and 32.6%, respectively. The mean difference in door‐to‐ ECG times for captured and missed patients was 31 minutes, with a range of 14 to 80 minutes of additional myocardial ischemia time for missed cases. The prevalence of primarily screened ED STEMI s was 0.09%. ED s with the greatest informedness (sensitivity+specificity−1) demonstrated superior performance across all other screening measures. Conclusions The 29.2% difference in MCRs between the highest and lowest performing ED s demonstrates room for improving timely STEMI identification among primarily screened ED patients. The MCR and informedness can be used to compare screening across ED s and to understand variable performance.
Yiadom et al. (Fri,) conducted a observational in ST-segment elevation myocardial infarction (STEMI). Emergency Department Screening Criteria for an Early ECG was evaluated on Missed case rate (MCR) for receiving an ECG within 15 minutes of ED arrival. Emergency department screening for early ECG in STEMI patients showed an overall missed case rate of 12.8% across 7 institutions, with performance varying widely from 3.4% to 32.6%.