Treffsicherheit der Notarzt-EKG-Diagnose bei STEMI-Patienten und Ihre Auswirkungen auf den klinischen Verlauf

by Sabri Mohamad
Doctoral thesis
Date of Examination:2024-07-09
Date of issue:2024-07-05
Advisor:Prof.Dr. Rüdiger Dißmann
Referee:Prof. Dr. Markus Roessler
Referee:Prof. Dr. Ralf Dressel
Persistent Address: http://dx.doi.org/10.53846/goediss-10584

 

 

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Abstract

English

The present data indicate that there is a need for further improvement in ECG interpretation by emergency physicians, as incorrect diagnoses were made in about one-third of STEMI patients. Notably, 22% of STEMI cases were not recognized by emergency physicians. Conversely, in 10% of the cases, incorrect STEMI diagnoses were made, leading to patients being directly transported to the catheter lab unnecessarily. Moreover, STEMIs that were not recognized by emergency physicians were associated with significantly prolonged treatment times (door-to-wire) in the hospital. Delays due to misdiagnoses were more pronounced during on-call hours compared to regular working hours. For patients with STEMI who were not clearly diagnosed pre-hospital but were definitively identified in the CoreLab, the time from hospital arrival to wire passage was more than twice as long as for patients with a clear STEMI diagnosis. Optimizing the care of STEMI patients requires improving pre-hospital diagnostic accuracy and enhancing ECG interpretation skills among emergency physicians. Since myocardial infarction care in Germany varies regionally, these findings may not be directly applicable to other regions. However, ensuring valid pre-hospital ECG interpretation should be a goal elsewhere as well. Collaborative discussions with hospitals and pre-hospital emergency physicians have already been initiated to improve heart attack management. Currently, the ability to diagnose emergency ECGs is explicitly included in the training standards of the medical association as part of the additional qualification in "emergency medicine." The training of emergency physicians should place a greater emphasis on ECG competence. Effective training and refresher programs should be organized in collaboration with medical associations, hospital cardiologists, and emergency physicians. A technically feasible way to optimize pre-hospital ECG diagnostics and accelerate reperfusion therapy is the telemedical transmission of challenging ECGs.
Keywords: Cardiology
 
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