Abstract P123: The Introduction of Prehospital ECGs into a Provincial System of STEMI Care: Impact on Treatment Delays and the Process of Care
Bibliographic record
Abstract
Background: Timely reperfusion therapy is associated with improved clinical outcomes in patients with ST-elevation myocardial infarction (STEMI). To improve treatment delays in Quebec (Canada), the Health Ministry set a goal of implanting prehospital ECG programs in all healthcare regions by the end of 2010. Objective: To investigate treatment delays and processes of care associated with the introduction of prehospital ECG programs in Quebec. Methods: All acute care Quebec hospitals that treated at least 30 acute myocardial infarctions (AMI) (n=82) participated in a systematic 6-month evaluation in 2008-9. Charts, prehospital ECGs and first in-hospital ECGs of all patients with a final diagnosis of AMI who presented to an emergency room with appropriate symptoms were reviewed to identify STEMI. Results: Of 1878 patients with STEMI who either received fibrinolysis or were sent for primary angioplasty (PPCI), 1118 (60%) came by ambulance. Of ambulance patients, 148 (13%) had a prehospital ECG. For 68% of these patients, there was an alert from the ambulance to the first emergency room. The prehospital ECG was transmitted to the first emergency room for 52% (77/148) of patients but a second in-hospital ECG was performed for 95% (141/148) of patients. The majority (61%) of patients with prehospital ECGs were brought directly to a PPCI center. However, almost 25% were brought to a non-PPCI center and then transferred to a PPCI center. In-hospital treatment delays were shorter in prehospital ECG patients without a substantial increase in the prehospital delay. However, even with a prehospital ECG, transferred patients experienced long delays to treatment. Conclusion: These findings suggest that the potential for improving times to treatment by implanting ECG programme depends on modifying the continuum of STEMI care. Specifically, the avoidance of unnecessary and time-consuming inter-hospital transfers should be the primary goal of a prehospital ECG program. Prehospital and in-hospital treatment delays in STEMI patients who presented by ambulance Type of reperfusion treatment Prehospital Delay First medical contact to triage Median (10-90 percentile) In-hospital Delay Triage to treatment Median (10-90 percentile) With prehospital ECG Without prehospital ECG With prehospital ECG Without prehospital ECG Fibrinolysis n=195 38 min (20-56) 28 min (18-50) 19 min (14-55) 29 min (13-73) Direct admission PPCI n=417 30 min (21-51) 29 min (19-45) 57 min (32-95) 78 min (43-170) PPCI with transfer n=506 28 min (17-48) 27 min (18-47) 97 min (69-172) 109 min (75-207)
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".