Prehospital ECG Interpretation Methods for ST-Elevation MI Detection and Catheterization Laboratory Activation: A Systematic Review and Meta-Analysis.
Introduction: The diagnostic accuracies of different electrocardiography (ECG) interpretation methods remain unclear. Therefore, this study aimed to systematically evaluate and compare the diagnostic accuracy of prehospital 12-lead ECG interpretation methods for identifying ST-elevation myocardial i...
| Publicado en: | Archives of Academic Emergency Medicine Vol. 13; no. 1; pp. 1 - 18 |
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| Autores principales: | , , , , , , , , , , |
| Formato: | research systematic review tables/charts Journal Article |
| Publicado: |
Shahid Beheshti University of Medical Sciences
2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=190500694&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 190500694 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 26454904 MFMK jtl: Archives of Academic Emergency Medicine issn: 26454904 maglogo: N pubinfo: dt: 2025 vid: 13 iid: 1 pid: 87963 pub: Shahid Beheshti University of Medical Sciences artinfo: ui: 190500694 190500694 190500694 10.22037/aaemj.v13i1.2627 190500694 ppf: 1 ppct: 17 formats: fmt: @attributes: type: P tig: atl: Prehospital ECG Interpretation Methods for ST-Elevation MI Detection and Catheterization Laboratory Activation: A Systematic Review and Meta-Analysis. aug: au: Alrawashdeh, Ahmad Ihtoub, Samar Alkhatib, Zaid I. Alwidyan, Mahmoud Khader, Yousef S. Rawashdeh, Sukaina Alqahtani, Saeed Stub, Dion Alhamouri, Rahaf Alkhazali, Islam E. Nehme, Ziad affil: Department of Allied Medical Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan. sug: subj: Electrocardiography Prehospital Care Methods ST Elevation Myocardial Infarction Diagnosis Heart Catheterization Decision Making, Clinical Evaluation Emergency Service False Positive Results Human Systematic Review Meta Analysis Medline CINAHL Database Descriptive Statistics Data Analysis Software ROC Curve Bivariate Statistics Confidence Intervals Regression Predictive Value of Tests Sensitivity and Specificity Female Male Adult Adult: 19-44 years Female Male ab: Introduction: The diagnostic accuracies of different electrocardiography (ECG) interpretation methods remain unclear. Therefore, this study aimed to systematically evaluate and compare the diagnostic accuracy of prehospital 12-lead ECG interpretation methods for identifying ST-elevation myocardial infarction (STEMI) and activating cardiac catheterization laboratories (CCLs). Methods: A comprehensive search was conducted in Medline, Scopus, and CINAHL databases up to August 2024. Two reviewers independently selected studies that assessed the diagnostic accuracy of prehospital 12-lead ECG in real-time STEMI identification and CCL activation. Pooled estimates of sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC) were calculated using bivariate generalized mixed-effects regression models or random-effects meta-analysis as appropriate. The quality of the included studies was assessed using the QUADAS-2 tool. Results: Thirty-six studies involving 67,168 patients were included. Overall, for STEMI identification, the pooled AUC of ECG was 0.96 (95%CI:0.94–0.98), sensitivity was 80% (95% CI, 69–88%), specificity was 97% (95%CI: 94–98%), and DOR was 114 (95%CI: 59–222). Ambulance clinicians achieved the highest DOR (264; 95%CI: 33–2125), followed by transmission method (136; 95%CI, 59–312) and computer-assisted analysis (78; 95%CI: 33–186). Transmission method demonstrated superior specificity (0.98; 95%CI: 0.94-0.99) and the lowest rates of inappropriate (13.2%; 95% CI: 8.6%–19.2%), and false-positive (11.0%; 95%CI: 6.9%–15.0%) CCL activations. Conclusion: All prehospital ECG interpretation methods yielded acceptable diagnostic accuracy for STEMI identification; however, transmission offered the greatest specificity and fewer unnecessary CCL activations. Adopting transmission-based strategies, where feasible, and enhancing training and decision support for ambulance clinicians may improve prehospital STEMI detection and resource utilization. pubtype: Academic Journal doctype: meta analysis research systematic review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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