Faculty Collaboration Database

Limitations of prehospital predictors of acute myocardial infarction and unstable angina. Ann Emerg Med 1987 Dec;16(12):1325-9

Date

12/01/1987

Pubmed ID

3688592

DOI

10.1016/s0196-0644(87)80412-2

Scopus ID

2-s2.0-0023606564 (requires institutional sign-in at Scopus site)   30 Citations

Abstract

Studies have attempted to define predictive indicators of diagnosis and/or prognosis for acute myocardial infarction (AMI) in the emergency department and to identify the need for hospital admission in patients with chest pain. Because prehospital predictors have not been defined, dispatchers, paramedics, and base station physicians continue to triage based on patient history. We reviewed 401 patients presenting in one year to an urban paramedic system with chest pain, normal vital signs, and stable rhythms to identify predictors of AMI and unstable angina. Thirty-one percent (123) had a diagnosis of AMI, 26% (105) unstable angina, and 43% (173) "other" diagnoses. Two-hundred seventy-eight patients required nitroglycerin administration, 182 required IV morphine, 14 developed arrhythmias requiring lidocaine, and two suffered cardiac arrest in the field. Nine other patients had a cardiac arrest after arrival in the ED. When comparing AMI and unstable angina patients to the "others," 64% (132) versus 36% (74) had radiation of pain (P less than .003), 72% (95) versus 28% (37) had diaphoresis (P less than .0001). Neither difficulty breathing, nausea/vomiting, vital signs, initial rhythm, nor past history of myocardial infarction were helpful in discriminating AMI and unstable angina from others. Comparing AMI alone versus others, the presence of ST segment elevation on lead II was present in 15% (18) AMIs, 3% (3) unstable angina, and 8% (14) others (P = .005). Diaphoresis also was a predictor of diagnosis with 51% (63) of the AMIs and 25% (69) of others exhibiting this sign (P less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Author List

Hargarten KM, Aprahamian C, Stueven H, Olson DW, Aufderheide TP, Mateer JR

Author

Tom P. Aufderheide MD Professor in the Emergency Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Angina Pectoris
Angina, Unstable
Chest Pain
Diagnosis, Differential
Electrocardiography
Emergency Medical Services
Female
Forecasting
Humans
Male
Middle Aged
Myocardial Infarction
Retrospective Studies
Sweating