Test of the Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-TIPI) for Prehospital Use☆,☆☆,★,★★
Section snippets
INTRODUCTION
Two acute cardiac ischemia (ACI) predictive instruments have been developed as diagnostic aids for hospital-based emergency physicians in the triage of patients with chest pain or other symptoms suggestive of acute ischemia. In 1984, Pozen et al1 developed a predictive instrument for ACI based on logistic regression for use in a handheld programmable calculator. This mathematic instrument provided an estimate of a patient's probability of having acute ischemia, based on seven clinical and ECG
MATERIALS AND METHODS
The Milwaukee County Paramedic System is a two-tiered urban emergency medical services system.7 For this study, all 10 Milwaukee County paramedic units were equipped with computerized, portable MAC PC 12-lead electrocardiographs (Marquette Electronics, Incorporated) coupled with cellular telephone transmission capability. The transmission of prehospital 12-lead ECGs has been demonstrated to be accurate and reliable.8
Prehospital 12-lead ECGs were acquired by Milwaukee County paramedics in phase
RESULTS
During a 6-month period (July 17, 1989, through January 1, 1990), the Milwaukee paramedics acquired and transmitted prehospital 12-lead ECGs for 439 adult prehospital chest pain patients. Seventy-seven patients (17%) were excluded because of incomplete data. Excluded patients did not differ significantly with respect to age, sex, final hospital diagnosis, or history of myocardial infarction, heart surgery, diabetes, or stroke. Excluded patients had a lower incidence of history of hypertension
DISCUSSION
Approximately 5 million patients present to EDs each year with chest pain or other symptoms suggesting acute ischemia.3 Approximately 50% of these patients are transported by EMS systems.6 Identifying the patients with true ACI (AMI or angina pectoris) is one of the most difficult challenges in emergency medicine.13 Physicians still rely mainly on the patient's presenting symptoms and ECG findings to determine initial patient disposition.14 Studies of emergency physicians demonstrate that they
Acknowledgements
The authors gratefully acknowledge and thank Paul Elko, Tony Holmes, and Marquette Electronics, Incorporated, for their valuable assistance; Michael H Milbrath, Judy E Larsen, Lauryl M Pukansky, and the Milwaukee County paramedics, without whose enthusiasm and dedication this project would not have been possible; Joni R Beshansky, RN, MPH, for her assistance in handling the ECGs and coding system for this study; and Dawn Kawa for her valuable assistance in preparing this manuscript.
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A tool for judging coronary care unit admission appropriateness valid for both real-time and retrospective use: A time-insensitive predictive instrument (ACI-TIPI) for acute cardiac ischemia: a multicenter study
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Impact of the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) on the speed of triage decision making for emergency department patients presenting with chest pain: A controlled clinical trial
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Cited by (29)
Cellular technology improves transmission success of pre-hospital electrocardiograms
2013, American Journal of Emergency MedicineCitation Excerpt :They were also instructed to continue attempts to transmit the ECG itself. Pre-hospital computer-interpreted electrocardiography has been shown to be an effective tool in identifying myocardial infarction, [20,21] although some authors [22,23] have found high false-positive rates (136/529, 26% and 9/23, 39%). With regard to both obtaining and transmitting ECGs, the most common reason overall was “unknown.”
Acute cardiac ischemia time-insensitive predictive instrument predicts exercise treadmill test results in the chest pain unit
2006, American Journal of Emergency MedicinePre-hospital 12-lead electrocardiography programs: A call for implementation by emergency medical services systems providing advanced life support - National Heart Attack Alert Program (NHAAP) Coordinating Committee; National Heart, Lung, and Blood Institute (NHLBI); national institutes of health
2006, Journal of the American College of CardiologyCitation Excerpt :The same report (42) found that the acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI), which prints the patient’s probability of having ACS on the electrocardiogram header, improved the diagnosis of ACS. Further research is needed to test the potential impact of ACI-TIPI on EMS-based identification of ACS (55). Pre-hospital 12-lead electrocardiography acquisition has been shown to be feasible and to result in earlier identification of patients with STEMI (39,56–59).
The prehospital 12-Lead electrocardiogram
2005, ECG in Emergency Medicine and Acute CareElectrocardiographic Predictive Instruments
2005, ECG in Emergency Medicine and Acute CareQT Dispersion
2005, ECG in Emergency Medicine and Acute Care
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From the Departments of Emergency Medicine* and Family and Community Medicine‡, Medical College of Wisconsin, and the Diagnostic Division, Marquette Electronics, Incorporated§, Milwaukee, Wisconsin; and the Division of Clinical Care Research, Tufts University School of Medicine, New England Medical Center, Boston, Massachusetts.∥
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Dr Aufderheide acted as a consultant to Marquette Electronics in developing the Marquette version of the ACI-TIPI. He has no direct financial interest in the ACI-TIPI or in Marquette Electronics. Dr Selker developed the originial ACI-TIPI but has had no involvement with Marquette Electronics.
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Address for reprints: Tom P Aufderheide, MD, Department of Emergency Medicine, Medical College of Wisconsin, 8700 West Wisconsin Avenue, DH-204, Milwaukee, Wisconsin 53226
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Reprint no. 47/1/70708