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Diagnostic performance and system delay using telemedicine for prehospital diagnosis in triaging and treatment of
Martin Boehme Rasmussen1, Lars Frost, Carsten Stengaard
1Department of Medicine, Silkeborg Regional Hospital and Cardiovascular Research Centre Viborg and Silkeborg Hospital & Institute of Clinical Medicine, Aarhus University Hospital, , Silkeborg, Denmark.
Insights
Telemedicine enables prehospital diagnosis and direct triage for ST-segment elevation myocardial infarction (STEMI) patients, confirming 84% of diagnoses. This approach allows 89% of patients within 95 km to receive primary percutaneous coronary intervention (PPCI) within 120 minutes of the emergency call.
Area of Science:
- Cardiology
- Emergency Medicine
- Health Services Research
Background:
- European guidelines advocate prehospital diagnosis for ST-segment elevation myocardial infarction (STEMI) to expedite reperfusion.
- Optimal system delays (first medical contact to primary percutaneous coronary intervention) are recommended but data on prehospital diagnosis and direct triage are limited.
Purpose of the Study:
- To assess the confirmation rate of prehospital STEMI diagnoses made via telemedicine.
- To determine system delays in patients diagnosed prehospital and directly triaged to percutaneous coronary intervention (PCI) centers.
Main Methods:
- A population-based follow-up study was conducted in the Central Denmark Region.
- 15,992 patients underwent telemedicine-based diagnosis.
- Data were analyzed for system delay from first medical contact (FMC) to PCI.
Main Results:
- A tentative STEMI diagnosis was established in 1061 patients, with 919 directly triaged to a PCI center.
- STEMI was confirmed in 771 (84%) patients.
- 89% of patients within 95 km of a PCI center received primary PCI within 120 minutes of FMC, though only 14% within 10 km achieved <60 min delay.
Conclusions:
- Telemedicine facilitates prehospital STEMI diagnosis and direct triage to catheterization labs, proving feasible.
- This strategy allows 89% of patients up to 95 km away to receive PPCI within 120 minutes of the emergency call.
- A system delay of <60 minutes from the initial emergency call is currently unachievable.
Objective:
European ST-segment elevation myocardial infarction (STEMI) guidelines recommend prehospital diagnosis to facilitate early reperfusion in patients with STEMI, and they provide recommendations regarding optimal system delay (time from first medical contact (FMC) to the primary percutaneous coronary intervention (PPCI)). There are limited data on achievable system delays in an optimal STEMI system of care using prehospital diagnosis to triage patients with STEMI directly to percutaneous coronary intervention (PCI) centres. We examined the proportion of tentative prehospital STEMI diagnoses established by telemedicine confirmed on hospital arrival, and we determined system delay in patients diagnosed before hospital arrival and triaged directly to the catheterisation laboratory.
Design:
Population-based follow-up study.
Setting:
Central Denmark Region.
Participants:
15 992 patients diagnosed using telemedicine.
Results:
During the study period, a tentative diagnosis of STEMI was established in 1061 patients, of whom 919 were triaged directly to the PCI centre. In 771 (84%) patients, a diagnosis of STEMI was confirmed. Patients transported <10 km had a mean system delay of 82 min; this delay rose to 103 min for patients transported 50-75 km. Data on system delay was achievable in 682 patients in whom 553 (81%) were treated within 120 min of the FMC, and a system delay of <120 min was achievable in 89% of patients living up to 95 km from the PCI centre. Even for patients living <10 km from the PCI centre, only 16 (14%) had a system delay of 60 min or less.
Conclusions:
The use of telemedicine for prehospital diagnosis and triage of patients directly to the catheter laboratory is feasible and allows 89% of patients living up to 95 km from the invasive centre to be treated with PPCI within 120 min of the emergency medical service call. The study confirms that a recommendation of a system delay <60 min is unachievable if the FMC is the emergency medical call.
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