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- W2022504883 abstract "To evaluate the diagnostic accuracy and outcomes for patients treated by use of a prehospital chest pain protocol (CPP).Consecutive case series for 1 year (1993) of prehospital nontrauma advanced life support (ALS) cases including hospital outcomes.Nonurban two-tiered emergency medical services system.Patients treated under the prehospital CPP or with hospital diagnoses of ischemic heart disease (IHD; ICD-9 between 410 and 414). Patients with cardiac arrest or dysrhythmias were excluded.Patients were given, by standing orders, ECG monitoring, i.v. access, and sublingual nitroglycerin. Further therapy was guided by on-line medical direction.Of 3,122 ALS nontrauma patients, 620 (20%) were treated with the CPP. All patients underwent ECG monitoring, i.v. access was started in 83%, and 61% received nitroglycerin. Only 55% of patients completed the entire CPP; patients who failed to complete the CPP had the same prevalence of IHD as those who completed it. When compared with hospital diagnosis of IHD, the CPP had a sensitivity of 69% (95% confidence interval [CI], 64% to 74%), a specificity of 87% (95% CI, 86% to 88%), and a positive predictive value of 42%. The positive likelihood ratio of CPP for IHD was 5.31, and the negative likelihood ratio was .36. The hospital mortality rate for all patients was 2.2%; for those with IHD, it was 1.6%.This prehospital ALS CPP had good diagnostic accuracy, but only half of patients completed it, and the hospital mortality rate was low. These data challenge the efficacy of the CPP." @default.
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- W2022504883 title "Evaluation of a Prehospital Chest Pain Protocol" @default.
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- W2022504883 doi "https://doi.org/10.1016/s0196-0644(95)70010-2" @default.
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