%0 Journal Article
%T Ischaemic Heart Disease: Accuracy of the Prehospital Diagnosis¡ªA Retrospective Study
%A Louise Houlberg Hansen
%A S£¿ren Mikkelsen
%J Emergency Medicine International
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/754269
%X Purpose. Correct prehospital diagnosis of ischaemic heart disease (IHD) may accelerate and improve the treatment. We sought to evaluate the accuracy of prehospital diagnoses of ischemic heart diseases assigned by physicians. Methods. The Mobile Emergency Care Unit (MECU) in Odense, Denmark, services a population of 260.000. All admissions in 2009 concerning patients diagnosed in the IHD category were assessed. Outcome and diagnosis of each patient were manually validated in accordance to the final diagnosis established following admission to hospital, using the discharge summary from the relevant department as reference. Results. 428 MECU runs with a prehospital diagnosis of IHD were registered. 422 of these were included in the study and 354 of those patients were suitable for this analysis. 73,4% of the patients hospitalized with a prehospital diagnosis of IHD were initially admitted to the relevant ward. Of these patients, 40,0% had their preliminary diagnosis of IHD confirmed. 14,1% of all patients admitted to the hospital were diagnosed with nonheart conditions. Preliminary diagnoses of STEMI had an accuracy of 87,5%. Conclusions. The preliminary IHD diagnoses assigned by the MECU physicians were acceptable. In case of STEMI patients the diagnostic accuracy was excellent. In this study there was an apparent overtriage. 1. Background Ischaemic heart disease (IHD) as a part of a general cardiovascular disease is the leading cause of death in Denmark and the leading cause of admission to hospitals in Denmark [1]. Other industrial countries follow the same pattern [2]. Large randomised trials have demonstrated that fibrinolytic therapy can reduce mortality in patients with suspected acute myocardial infarction (AMI) [3]. Furthermore, it is known that reducing time to reperfusion decreases morbidity and mortality [3, 4]. This knowledge calls for making a fast assessment of the patient¡¯s risk of having acute coronary syndrome (ACS). The simple solution to this problem is to admit all patients, even the ones with low suspicion of acute ischaemia, to specialized cardiac centres. This concept, ¡°Chest Pain Clinics,¡± is increasingly gaining acceptance, but there are potential drawbacks to sending all patients with chest pain to the same department, regardless of eliciting factor. This practice may lead to a poor cost-effectiveness and overtriage. To eliminate these drawbacks, a diagnostic tool is needed to separate the patients in need of fibrinolytic therapy from other patients. This is yet to be discovered and often the decision to admit a patient to a
%U http://www.hindawi.com/journals/emi/2013/754269/