Abstract 19118: Symptom Predictors of Delayed ST-Elevation Myocardial Infarction Presentation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Pawan Hari ◽  
Maithili Shenoy ◽  
Tanya Doctorian ◽  
David Choe ◽  
Amar Desai ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Chest Pain ◽  
Symptom Onset ◽  
Emergency Services ◽  
Onset Time ◽  
Tertiary Hospital ◽  
Ischemic Time ◽  
Education And Awareness ◽  
Symptom Predictors ◽  
Door To Balloon

Introduction: Through various systematic initiatives, cardiac centers routinely reach targeted door-to-balloon (DTB) treatment times of less than 90 minutes resulting in improved outcomes. However, in an effort to further optimize outcomes, by reducing total ischemic time, focus on symptom onset and their impact on presentation is needed. Hypothesis: This study aimed to identify whether the type and nature of specific symptoms are associated with delays in presentation in STEMI patients. Methods: 549 patients with complete data presenting with STEMI from April 2008 to December 2012 to a tertiary hospital were retrospectively studied. False activations were excluded. 449 patients were included in this analysis. Symptom-onset-to-hospital arrival time (symptom-onset time was identified by review of medical records, pre-hospital emergency services data and by interviewing patient’s and their family) was analyzed for the following factors: type of symptoms (chest pain, dyspnea, cardiac arrest) and nature of symptoms (constant or intermittent). Non-parametric univariate and multivariate analyses (PROC GLIMMIX) were carried out using Statistical Analysis Systems version 9.1 (SAS Institute, Cary, NC) statistical software package. Results: See table Conclusion: As expected, STEMI patients presenting with cardiac arrest who survived pre-hospital resuscitation presented the fastest, while patients with dyspnea had a significantly longer delay than patients with chest pain. Patients with intermittent symptoms presented significantly later than those with constant symptoms. Of particular interest, symptom-onset-to-door presentation remains long even with the classical symptom of constant chest pain (the most common STEMI symptom presentation). Thus, continued and enhanced population education and awareness is necessary to see further significant decreases in total ischemic time in STEMI patients.

Abstract 13955: Establishing a Prehospital Protocol for Local Emergency Services Improves Symptom Onset-to-Balloon Time in Patients With ST-Segment Elevation Myocardial Infarction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Dawn A Brester ◽  
Matthew Schmidt ◽  
William T Witmer ◽  
Scott T Weslow ◽  
David Mathias ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Symptom Onset ◽  
Emergency Services ◽  
Community Education ◽  
Team Approach ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Door To Balloon ◽  
The Impact

Background: Delay in symptom recognition and calling 911 for patients with ST-segment elevation myocardial infarction (STEMI) continues to challenge many hospitals’ STEMI systems. Research has historically focused on door-to-balloon time and inpatient treatment, with little known on the impact of engaging emergency services (EMS) to provide a team approach to patient care, from community education to prehospital activation. Purpose: Evaluate the impact of a collaboration with local EMS agencies in our institution’s STEMI system designed to develop a prehospital protocol and joint community education efforts. Methods: Data collected from NCDR ACTION Registry-Mission Lifeline reports from 2011 to 2013 was analyzed to identify recent trends in prehospital STEMI quality metrics. After evaluation of 2011 data, a regional plan was developed and implemented in 2012 to address prehospital system barriers, including public education and revision of a prehospital protocol. Results: In 2011, a majority of patients used private transport when having a STEMI. Following protocol implementation, STEMI patients were able to identify symptoms earlier and appropriately call 911 earlier. As a result, a first medical contact (FMC)-to-balloon time of < 90 minutes increased to 72% of patients, time from symptom onset to balloon decreased, and postprocedure complication rate improved (Table). Conclusions: Establishing a collaborative prehospital protocol between hospitals and EMS can have a positive impact on outcomes in STEMI patients. With more awareness and earlier notification of incoming STEMI patients, hospitals can significantly decrease symptom onset-to-balloon time. Evaluation of time from symptom onset to device activation may be a better way to measure quality than door-to-balloon time, as evidenced by a decrease in postprocedure complications associated with decreased overall times.

scholarly journals Prehospital times in primary percutaneous coronary intervention: The new frontier for improvement

2020 ◽  
Vol 46 (2) ◽  
Author(s):  
James A Kiberd ◽  
George Kephart ◽  
Iqbal Bata ◽  
Ata-Ur Quraishi
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Symptom Onset ◽  
Hospital Setting ◽  
Coronary Intervention ◽  
Ischemic Time ◽  
Percutaneous Coronary ◽  
Short And Long Term ◽  
St Elevation ◽  
Door To Balloon

Background: Primary percutaneous coronary intervention (PPCI) remains the treatment of choice for patients presenting with ST-elevation myocardial infarction (STEMI). With STEMI, total ischemic time is an important predictor of myocardial injury and other short and long-term adverse events including mortality. Several studies have examined ‘Door to Balloon’ times, but few studies have examined pre-hospital and in hospital component times as individual pieces that make up total ischemic time. Methods: Total ischemic and component times for patients who received PPCI from 2012- 2015 in the Queen Elizabeth-II Halifax Infirmary were described. Median total ischemic times and component times were calculated and compared. Regression modeling was performed to identify which component times and component variables explained the most variation in total ischemic times. Results: 551 patients who had successful PPCI and complete component times were identified. Most were male (76%) with a median age of 59.2 years (IQR: 52.7-68.0 years). The longest component time was ‘Symptom Onset to First Medical Contact’ (Median: 61 min, IQR: 32-138 min). ‘Symptom Onset to First Medical Contact’ was found to account for most of the variation seen in total ischemic time (R2= 61%). Conclusions: We determined that most time in the component of receiving PPCI lies in the pre-hospital setting and that component variables including EHS use and pre-activation of the cardiac catheter lab reduce total ischemic time. More research needs to be devoted to reducing patient delay, as thereappears to be little room for improvement in hospital component times.

scholarly journals SURF: identifying and allocating resources during Out-of-Hospital Cardiac Arrest

2020 ◽  
Vol 20 (S11) ◽  
Author(s):  
Gaurav Rao ◽  
Salimur Choudhury ◽  
Pawan Lingras ◽  
David Savage ◽  
Vijay Mago
Keyword(s):  
Cardiac Arrest ◽  
Linear Programming ◽  
Integer Linear Programming ◽  
Processing Time ◽  
Emergency Services ◽  
Linear Programming Method ◽  
Bipartite Matching ◽  
Matching Algorithm ◽  
Hospital Cardiac Arrest ◽  
Cardiac Emergency

Abstract Background When an Out-of-Hospital Cardiac Arrest (OHCA) incident is reported to emergency services, the 911 agent dispatches Emergency Medical Services to the location and activates responder network system (RNS), if the option is available. The RNS notifies all the registered users in the vicinity of the cardiac arrest patient by sending alerts to their mobile devices, which contains the location of the emergency. The main objective of this research is to find the best match between the user who could support the OHCA patient. Methods For performing matching among the user and the AEDs, we used Bipartite Matching and Integer Linear Programming. However, these approaches take a longer processing time; therefore, a new method Preprocessed Integer Linear Programming is proposed that solves the problem faster than the other two techniques. Results The average processing time for the experimentation data was   1850 s using Bipartite matching,   32 s using the Integer Linear Programming and  2 s when using the Preprocessed Integer Linear Programming method. The proposed algorithm performs matching among users and AEDs faster than the existing matching algorithm and thus allowing it to be used in the real world. Conclusion: This research proposes an efficient algorithm that will allow matching of users with AED in real-time during cardiac emergency. Implementation of this system can help in reducing the time to resuscitate the patient.

scholarly journals Modelling improved efficiency in healthcare referral systems for the urban poor using a geo-referenced health facility data: the case of Sylhet City Corporation, Bangladesh

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Alayne M. Adams ◽  
Rushdia Ahmed ◽  
Shakil Ahmed ◽  
Sifat Shahana Yusuf ◽  
Rubana Islam ◽  
...  
Keyword(s):  
Critical Care ◽  
Urban Poor ◽  
Emergency Services ◽  
Census Data ◽  
Service Providers ◽  
Healthcare Services ◽  
Tertiary Hospital ◽  
Care Services ◽  
Referral Systems ◽  
Alternative Scenarios

Abstract Background An effective referral system is critical to ensuring access to appropriate and timely healthcare services. In pluralistic healthcare systems such as Bangladesh, referral inefficiencies due to distance, diversion to inappropriate facilities and unsuitable hours of service are common, particularly for the urban poor. This study explores the reported referral networks of urban facilities and models alternative scenarios that increase referral efficiency in terms of distance and service hours. Methods Road network and geo-referenced facility census data from Sylhet City Corporation were used to examine referral linkages between public, private and NGO facilities for maternal and emergency/critical care services, respectively. Geographic distances were calculated using ArcGIS Network Analyst extension through a “distance matrix” which was imported into a relational database. For each reported referral linkage, an alternative referral destination was identified that provided the same service at a closer distance as indicated by facility geo-location and distance analysis. Independent sample t-tests with unequal variances were performed to analyze differences in distance for each alternate scenario modelled. Results The large majority of reported referrals were received by public facilities. Taking into account distance, cost and hours of service, alternative scenarios for emergency services can augment referral efficiencies by 1.5–1.9 km (p < 0.05) compared to 2.5–2.7 km in the current scenario. For maternal health services, modeled alternate referrals enabled greater referral efficiency if directed to private and NGO-managed facilities, while still ensuring availability after working-hours. These referral alternatives also decreased the burden on Sylhet City’s major public tertiary hospital, where most referrals were directed. Nevertheless, associated costs may be disadvantageous for the urban poor. Conclusions For both maternal and emergency/critical care services, significant distance reductions can be achieved for public, NGO and private facilities that avert burden on Sylhet City’s largest public tertiary hospital. GIS-informed analyses can help strengthen coordination between service providers and contribute to more effective and equitable referral systems in Bangladesh and similar countries.

Abstract P138: Improving Emergency Medical Services Documentation of Time Last Known Well

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Dot Bluma ◽  
Jessica Link Reeve ◽  
Susan M Godersky
Keyword(s):  
Emergency Medical Services ◽  
Symptom Onset ◽  
Systems Of Care ◽  
Onset Time ◽  
Reperfusion Therapy ◽  
Report Card ◽  
Medical Services ◽  
Emergency Department Physician ◽  
Measure Data ◽  
Emergency Medical

Background and Purpose: In a systems of care model, Emergency Medical Services (EMS) reporting a patient’s last known well (LKW) time to the receiving hospital is crucial for activation of the hospitals Acute Stroke Team. There is evidence that LKW is critical information for determining an acute ischemic stroke patient’s eligibility for advanced stroke therapy which includes intravenous Alteplase and/or mechanical endovascular reperfusion therapy. The 70 Wisconsin (WI) Coverdell Stroke Program (Coverdell) hospitals represent 80% of stroke admissions in WI. Coverdell developed a pre-arrival report card in Q3 2018 in which LKW was a tracked measure. Data entered into Get With The Guidelines®- Special Initiatives (SI) tab was collated to create the report card. After analysis of the data it was determined our performance improvement (PI) project would be to improve EMS’s documentation and reporting of time LKW. In Q3 2018, of those cases entered into the SI tab, EMS reporting a LKW time was 50%. Since LKW is not always obtainable, the project goal was set at 60%. Methods: We recognized implementation of this PI initiative would require a multi-prong approach. To assist EMS agencies in understanding the difference between LKW and symptom onset, we developed a document entitled, The Importance of an Accurate Last Known Well and Symptom Onset Time . A Coverdell team member attended WI’s EMS Physician Advisory Committee meetings where LKW data was discussed. In addition, an Emergency Department Physician hosted a webinar where the presentation highlighted the importance of documenting LKW. This webinar was recorded and sent to EMS agencies and hospitals. For loop closure and with the support of the WI’s EMS Director, LKW became a validated field for EMS in the WI Ambulance Run Data System. Findings: In Q2 2019 there was an improvement in documented LKW as evidenced by an increase to 59.2% The data has remained consistent even as more hospitals have begun to enter the data as demonstrated by the increasing N. Conclusion: The actions taken by the Coverdell program in educating EMS providers on the rationale and importance of LKW documentation was successful. However, additional efforts are required to reach and maintain the project goal of 60% with an additional stretch goal to 70%.

scholarly journals Analytical and diagnostic performances of a high-throughput immunoassay for SARS-CoV-2 IgM and IgG

2020 ◽  
Author(s):  
Andrea Padoan ◽  
Chiara Cosma ◽  
Paolo Zaupa ◽  
Mario Plebani
Keyword(s):  
Sensitivity And Specificity ◽  
Symptom Onset ◽  
Severe Disease ◽  
Onset Time ◽  
Time Frame ◽  
Serum Samples ◽  
Time Period ◽  
Analytical Imprecision ◽  
Range Of Values

BackgroundAbstractReliable SARS-CoV-2 serological assays are required for diagnosing infections, for the serosurveillance of past exposures and for assessing the response to future vaccines. In this study, the analytical and clinical performances of a chemiluminescent immunoassays for SARS-CoV-2 IgM and IgG detection (Mindray CL-1200i), targeting Nucleocapsid (N) and receptor binding domain (RBD) portion of the Spike protein, were evaluated.MethodsPrecision and linearity were evaluated using standardized procedures. A total of 157 leftover serum samples from 81 hospitalized confirmed COVID-19 patients (38 with moderate and 43 with severe disease) and 76 SARS-CoV-2 negative subjects (44 healthcare workers, 20 individuals with rheumatic disorders, 12 pregnant women) were included in the study. In an additional series of 44 SARS-CoV-2 positive, IgM and IgG time kinetics were also evaluated in a time-period of 38 days.ResultsPrecision was below or equal to 4% for both IgM and IgG, in all the studied levels, whilst a slightly significant deviation from linearity was observed for both assays in the range of values covering the manufacturer’s cut-off. Considering a time frame ≥ 12 days post symptom onset, sensitivity and specificity for IgM were 92.3% (95%CI:79.1%-98.4%) and 92.1% (95%CI:83.6%-97.0%). In the same time frame, sensitivity and specificity for IgG were 100% (95%CI:91.0%-100%) and 93.4% (95%CI:85.3%-97.8%). The assays agreement was 73.9% (Cohen’s kappa of 0.373). Time kinetics showed a substantial overlapping of IgM and IgG response, the latter values being elevated up to 38 days from symptoms onset.ConclusionsAnalytical imprecision is satisfactory as well as the linearity, particularly when taking into account the fact that both assays are claimed to be qualitative. Diagnostic sensitivity of IgG was excellent, especially considering specimens collected ≥12 days post symptom onset. Time kinetics suggest that IgM and IgG are detectable early in the course of infection, but the role of SARS-CoV-2 antibodies in clinical practice still requires further evaluations.

Abstract P153: SARS-CoV-2 (COVID-19) Protection Efforts on Acute Stroke Treatment

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Jessica Greenwood ◽  
Starlie Belnap ◽  
Rodney Bedgio ◽  
Guilherme Dabus ◽  
Italo Linfante ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Endovascular Treatment ◽  
Acute Stroke ◽  
Symptom Onset ◽  
Onset Time ◽  
Fold Increase ◽  
Medical Attention ◽  
Hospital Treatment ◽  
Significant Delay ◽  
The Impact

Introduction: It is unclear how the interventions designed to restrict community and in-hospital exposure to the SARS-CoV-2 virus affected the care for stroke patients seeking acute treatment. The objective of the following study was to determine the impact COVID-19 has had on the treatment times for patients evaluated as acute stroke alerts at Baptist Hospital of Miami (BHM). A co-primary objective of the study was to assess the risk of contracting SARS-CoV-2 within 2 weeks from hospital discharge. Methods: This retrospective, two phase study was conducted between December 2019 and April 2020. In phase one, we assessed time from symptom onset to hospital arrival, number of strokes with witnessed onset, and in-hospital treatment times pre & post implementation of Covid-19 preventive exposure measures. In phase two of the study, a telephone survey was conducted on the post implementation group to assess the risk of patients developing symptoms or testing positive for SARS-CoV-2 from hospital admission up to two weeks post discharge. Results: Phase I demonstrated there was a 40% decline in stroke volume, but no significant delay to seek medical attention post implementation of the SARS prevention strategies. On average individuals in the pre-group (n=155) waited approximately 260 minutes (SE=24) to seek medical attention vs. 203 minutes (SE=27) minutes for the post-group (n=87). However, there was nearly a six-fold increase in the percentage of cases with unknown symptom onset post implementation of COVID-19 safety precautions. There was significant delay in administering IV alteplase, increasing from 24 mins (n=16) to 33 mins (n=21) post implementation; delays observed for endovascular treatment were not significant (pre, n=13 mean= 73 mins, post n=12 mean= 82 mins). The volume of patients treated with either IV alteplase and/or endovascular treatment remained similar. Phase II of the study is on-going, results will be available for the ISC. Discussion: The COVID-19 crisis in our community was associated with a six-fold increase in the percentage of cases with unknown stroke onset time. Besides a marked decrease in stroke volume, we did not evidence significant delays to either seek or provide acute stroke care outside a modest increase in door to needle time.

CLINICAL STUDY OF POST COVID SYMPTOMS AFTER 1ST WAVE OF COVID 19, AT A TERTIARY HOSPITAL

2021 ◽  
pp. 51-53
Author(s):  
Dilip Pandurang Patil
Keyword(s):  
Chest Pain ◽  
Tertiary Hospital ◽  
Residual Effects ◽  
Chronic Obstructive ◽  
Age Group ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Female Ratio ◽  
Raising Awareness ◽  
Cognitive Disturbances

Background: Early reports suggest residual effects of SARS-CoV-2 infection, such as fatigue, dyspnea, chest pain, cognitive disturbances, arthralgia and decline in quality of life. In present study we aimed to evaluate post covid symptoms after 1st wave of COVID 19 in COVID 19 recovered patients at a tertiary hospital. Present study was Material and Methods: hospital based, descriptive, cross-sectional, questionnaire-based study conducted in Covid 19 positive patients (RT-PCR or Rapid Antigen positive patients) either hospital admitted or home isolation patients, recovered (either RTPCR negative or completed 14 days isolation and no symptoms) came to post covid OPD for follow up, were studied. In present study 101 post Results: COVID 19 recovered patients were studied. Most of patients were from age group 51-60 years (19.8 %) followed by age group 41-50 years (16.83 %). Male patients (65.35 %) were more than female patients (34.65%), male to female ratio was 1.9 :1. Majority of patients received treatment at hospital (75.25%) & were diagnosed by RTPCR (57.43%). Most of patients had recovered from COVID 61-90 days ago (28.71%) followed by 121-150 days ago (19.8%). During acute COVID-19 pneumonia was diagnosed in 36.63 % cases. Other characteristics were intensive care unit admission (14.85 %), oxygen supplementation (21.78 %), noninvasive ventilation (7.92 %) & mechanical ventilation (2.97 %). Pre-existing comorbidities noted were hypertension (12.87 %), thyroid disease (4.95 %), diabetes (3.96 %), chronic obstructive pulmonary disease (3.96 %), h/o kidney failure (1.98 %), active smoker (8.91 %) & former smoker (14.85 %). No regular physical activity was noted in 83.17 %. Post COVID symptoms noted in present study were cough (14.85 %), fatigue (13.86 %), Breathlessness (8.91 %), headaches (5.94 %), myalgia (3.96 %), palpitation (3.96 %), loss of smell sensation (3.96 %), muscle weakness (2.97 %), loss of taste sensation (2.97 %) & chest pain (1.98 %). Most of the Conclusion: COVID-19 survivors experienced mild post-recovery symptoms such as cough, fatigue, breathlessness, headache, myalgia & palpitation. Raising awareness, recognition, research, and multidisciplinary involvement will be considered the cornerstones to manage long-term sequelae of COVID-19 effectively.

Abstract WP112: Thrombolysis for AIS in the Unwitnessed or Extended Therapeutic Time Window: A Systematic Review and Meta-Analysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Aristeidis H Katsanos ◽  
Konark Malhotra ◽  
Amrou Sarraj ◽  
Andrew Barreto ◽  
Martin Köhrmann ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Time Window ◽  
Meta Analysis ◽  
Onset Time ◽  
Intravenous Thrombolysis ◽  
Functional Independence ◽  
Functional Improvement ◽  
Increased Risk ◽  
Significant Difference ◽  
All Cause Mortality

Introduction: We sought to assess the utility of intravenous thrombolysis (IVT) treatment in acute ischemic stroke (AIS) patients with unclear symptom onset time or outside the 4.5 hour time window, selected by advanced neuroimaging. Methods: We performed random-effects meta-analyses on the unadjusted and adjusted for potential confounders associations of IVT (alteplase 0.9 mg/kg) with the following outcomes: 3-month favorable functional outcome [FFO, modified Rankin Scale (mRS) scores: 0-1], 3-month functional independence (FI, mRS-scores: 0-2), 3-month mortality, 3-month functional improvement (assessed with ordinal analysis on the mRS-scores), symptomatic intracranial hemorrhage (sICH) and complete recanalization (CR). Results: We identified 4 eligible RCTs (859 total patients). In unadjusted analyses IVT was associated with higher likelihood of 3-month FFO (OR=1.48, 95%CI:1.12-1.96), FI (OR=1.42, 95%CI:1.07-1.90), sICH (OR=5.28, 95%CI:1.35-20.68) and CR (OR=3.29, 95%CI:1.90-5.69), with no significant difference in the odds of all-cause mortality risk at three months (OR=1.75, 95%CI: 0.93-3.29). In the adjusted analyses IVT was also associated with higher odds of 3-month FFO (OR adj =1.62, 95%CI:1.20-2.20), functional improvement (OR adj =1.42, 95%CI: 1.11-1.81) and sICH (OR adj =6.22, 95%CI: 1.37-28.26). There was no association between IVT and FI (OR adj =1.61, 95%CI: 0.94-2.75) or all-cause mortality at three months (OR adj =1.75, 95%CI: 0.93-3.29). No evidence of heterogeneity was evident in any of the analyses (I 2 =0). Conclusion: IVT in AIS patients with unknown symptom onset time or elapsed time from symptom onset more than 4.5 hours, selected with advanced neuroimaging, results in a higher likelihood of complete recanalization and functional improvement at three months despite the increased risk of sICH.

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