Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz

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Gewählte Publikation:

Gemes, G.
The acute coronary syndrome - prehospital diagnostic and therapeutic quality.
[ Dissertation ] Medical University of Graz; 2004. pp.48.


Autor*innen der Med Uni Graz:
Gemes Geza
Prause Gerhard
Stoschitzky Kurt

Background and objective: In the Austrian emergency medical service (EMS), EMT-staffed and physician-staffed vehicles are in operation. Patients with suspected acute coronary syndromes (ACS) are prehospitally treated and transported to hospital by an emergency physician (EP). This study evaluates the diagnostic quality of EPs in ACS and their impact on outcome in an urban area. Design: Retrospective case control study. Methods: All protocol sheets of the emergency physicians were searched for the diagnose of ACS. The database of the emergency department (ED) was searched of patients with ACS as admission diagnose of ACS as discharge diagnose. For patients taken to an intensive care unit (ICU), the medical histo4y from the ICU was reviewed. All data were matched and input into a database containing every patient who had either a suspected of a confirmed ACS in the medical history. According to the diagnose and the aggressiveness of therapy, each patient was assigned a five-step-score at every stage of care (prehospital score, ED score, ICU store). Results: Altogether, 3585 patients were included. Only 17,8% of the patients with ACS as admission diagnose and 20,3% of the patients with ACS as discharge diagnose were transported by an EP. 46,8% of the ACS diagnosed by EPs were confirmed in hospital. Patients transported by the EP showed a higher all-cause mortality in hospital (106% vs. 0,6%; p = 0,011). Prehospital thrombolytic treatment did not affect outcome. We found no significant correlation between the prehospital score by EPs and the ED score. When a 12-lead-electrocardiogramm was recorded, the correlation improved slightly (rho: 0,139; p = 0,006). Conclusions: The percentage of ACS patients transported to hospital by an EP is very low, whereas the EPs seem to be over-aware in the diagnose of ACS. The prehospital presence of an EP does not improve short-term mortality in ACS.

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