A Novel Algorithm for Improving the Prehospital Diagnostic Accuracy of ST-Segment Elevation Myocardial Infarction.
A Novel Algorithm for Improving the Prehospital Diagnostic Accuracy of ST-Segment Elevation Myocardial Infarction.
复制标题
一种提高 ST 段抬高型心肌梗死院前诊断准确性的新算法。
DOI：
10.1017/s1049023x23006635
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发表时间：
2024
影响因子：
2.2
通讯作者：
Bosson,Nichole
中科院分区：
文献类型：
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作者：
Goebel,Mat;Westafer,LaurenM;Ayala,StephanieA;Ragone,El;Chapman,ScottJ;Mohammed,MasoodR;Cohen,MarcR;Niemann,JamesT;Eckstein,Marc;Sanko,Stephen;Bosson,Nichole
在院前心电图（ECG）上早期发现ST段抬高型心肌梗死（STEMI）可改善患者预后。目前的软件算法优化灵敏度，但有很高的假阳性率。作者提出了一种算法，以提高特异性的ST段抬高型心肌梗死诊断在院前setting.MethodsA数据集的院前心电图与验证的结果被用来验证算法，以确定真正的和假阳性的软件解释ST段抬高型心肌梗死。应用了先前研究中涉及的区分STEMI真阳性的四个标准：心率<130，QRS <100，ST段抬高的验证，以及没有伪影。的测试特性进行了计算和回归分析被用来检查的标准和测试characteristics.ResultsThere的数量之间的关联有44,611例可用。其中，1，193例通过软件判读被确定为STEMI。应用所有四个标准的阳性似然比最高为353（95% CI，201-595），特异性为99.96%（95% CI，99.93-99.98），但敏感性最低（14%; 95% CI，11-17），阴性似然比最差（0.86; 95% CI，0.84-0.89）。有很强的正似然比（r2 = 0.90）和特异性（r2 = 0.85）与越来越多的criteris.ConclusionsPrehospital心电图与真正的STEMI的可能性高，可以准确地确定使用这四个标准：心率<130，QRS <100，验证ST段抬高，没有伪影之间的相关性。将这些标准应用于具有STEMI软件解释的院前ECG可以减少假阳性场激活，同时也减少了依赖于医生过度读取的传输的需要。这可能对紧急医疗服务（EMS）系统产生重大的临床和质量影响。
IntroductionEarly detection of ST-segment elevation myocardial infarction (STEMI) on the prehospital electrocardiogram (ECG) improves patient outcomes. Current software algorithms optimize sensitivity but have a high false-positive rate. The authors propose an algorithm to improve the specificity of STEMI diagnosis in the prehospital setting.MethodsA dataset of prehospital ECGs with verified outcomes was used to validate an algorithm to identify true and false-positive software interpretations of STEMI. Four criteria implicated in prior research to differentiate STEMI true positives were applied: heart rate <130, QRS <100, verification of ST-segment elevation, and absence of artifact. The test characteristics were calculated and regression analysis was used to examine the association between the number of criteria included and test characteristics.ResultsThere were 44,611 cases available. Of these, 1,193 were identified as STEMI by the software interpretation. Applying all four criteria had the highest positive likelihood ratio of 353 (95% CI, 201-595) and specificity of 99.96% (95% CI, 99.93-99.98), but the lowest sensitivity (14%; 95% CI, 11-17) and worst negative likelihood ratio (0.86; 95% CI, 0.84-0.89). There was a strong correlation between increased positive likelihood ratio (r2 = 0.90) and specificity (r2 = 0.85) with increasing number of criteria.ConclusionsPrehospital ECGs with a high probability of true STEMI can be accurately identified using these four criteria: heart rate <130, QRS <100, verification of ST-segment elevation, and absence of artifact. Applying these criteria to prehospital ECGs with software interpretations of STEMI could decrease false-positive field activations, while also reducing the need to rely on transmission for physician over-read. This can have significant clinical and quality implications for Emergency Medical Services (EMS) systems.