ECG prediction tools: just a gimmick?

This study examines whether decision support provided by the electrocardiograph (ECG)-based, acute cardiac ischemia time-insensitive predictive instrument (ACI-TIPI) and the thrombolytic predictive instrument (TPI) can help improve accuracy of diagnosis, triage and ultimately treatment of acute coronary syndrome (ACS) and ST elevation myocardial infarction (STEMI) when used in the prehospital setting.

Selker et al's paper describes the implementation of emergency medical service (EMS) use of ACI-TIPI and the TPI in prehospital settings to evaluate their impact on paramedic on-site identification of STEMI and ACS, and to see if they improve paramedic diagnostic performance of these conditions which in turn could improve care and clinical outcomes for patients.

It was also undertaken to see whether use of these instruments could increase accurate identification of candidates for participation in the IMMEDIATE trial (www.immediatetrial.com).

The study was conducted in three different phases involving 11 sites in America. Patients eligible for enrolment were all those ≥ 30 years old with symptoms consistent with ACS and who had an ECG performed by a paramedic. Phase 1 saw paramedics in 4 sites (with at least 2 years experience of performing ECGs in prehospital settings) further trained in ECG interpretation and the conventional use of ACI-TIPI and TPI with predictive values (0-100%) printed on the ECG headers. Paramedics were also instructed to use their own judgement to assess whether the patient was experiencing ACS based on clinical presentation and ECG abnormalities.