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Symptom severity as a predictor of reported differences of prehospital delay between medical records and structured
Yoshimi Fukuoka1, Kathleen Dracup, Miyoshi Ohno
1Department of Physiological Nursing, University of California San Francisco, 2 Koret Way, Room N611E, San Francisco, CA 94143-0604, USA. hina@itsa.ucsf.edu
Background:
The time interval from symptom onset to hospital arrival can guide the decision to start reperfusion for patients with acute myocardial infarction (AMI).
Aims:
The aims of the study were 1) to examine the consistency and agreement of prehospital delay time between medical record review and structured patient interview and 2) to identify whether symptom severity is an independent predictor of differences in reported prehospital delay between these two data sources.
Methods:
In this cross-sectional study, a convenience sample of 155 patients with AMI in Japan was recruited. The time and date of symptom onset were obtained from medical record review and a structured patient interview. The interviewer asked about severity of symptoms, using a scale on 0 to 10 scale, with 0 being "no symptom" and 10 being "the most severe symptoms imaginable".
Results:
The prehospital delay time from the medical record was significantly shorter than from the structured interview. Perfect agreement of reported prehospital delay time between two data sources was found in 46% of patients. Patients with symptom severity scores of greater than 8 on a 10-point scale were 2.2 times (95% CI: Odds Ratio 1.1 to 5.1) more likely to report different symptom onset time.
Conclusions:
Prehospital delay time documented in the medical record was shorter than that identified from a structured interview. In addition, the discrepancy between the two data sources may be larger in those patients with severe AMI symptoms.
