Optimizing an Emergency Medical Dispatch System to Improve Prehospital Diagnosis and Treatment of Acute Coronary Syndrome: Nationwide Retrospective Study in China

作者全名："Dong, Xuejie; Ding, Fang; Zhou, Shuduo; Ma, Junxiong; Li, Na; Maimaitiming, Mailikezhati; Xu, Yawei; Guo, Zhigang; Jia, Shaobin; Li, Chunjie; Luo, Suxin; Bian, Huiping; Luobu, Gesang; Yuan, Zuyi; Shi, Hong; Zheng, Zhi-jie; Jin, Yinzi; Huo, Yong"

作者地址："[Dong, Xuejie; Zhou, Shuduo; Ma, Junxiong; Li, Na; Maimaitiming, Mailikezhati; Yuan, Zuyi; Shi, Hong; Zheng, Zhi-jie; Jin, Yinzi; Huo, Yong] Peking Univ, Sch Publ Hlth, Dept Global Hlth, Beijing, Peoples R China; [Dong, Xuejie; Zhou, Shuduo; Ma, Junxiong; Li, Na; Maimaitiming, Mailikezhati; Zheng, Zhi-jie; Jin, Yinzi; Huo, Yong] Peking Univ, Inst Global Hlth & Dev, Beijing, Peoples R China; [Ding, Fang] Emergency Med Dispatcher Ind, Beijing, Peoples R China; [Xu, Yawei] Shanghai Tenth Peoples Hosp, Dept Cardiol, Shanghai, Peoples R China; [Guo, Zhigang; Li, Chunjie] Tianjin Chest Hosp, Dept Cardiol Surg, Tianjin, Peoples R China; [Jia, Shaobin] Gen Hosp Ningxia Med Univ, Dept Cardiol, Ningxia, Peoples R China; [Luo, Suxin] Chongqing Med Univ, Dept Cardiol, Affiliated Hosp 1, Chongqing, Peoples R China; [Bian, Huiping] Qinghai Prov Cardiocerebrovasc Dis Specialist Hosp, Dept Cardiol, Xining, Peoples R China; [Luobu, Gesang] Tibet Autonomous Reg Peoples Hosp, Dept Cardiol, Lasa, Peoples R China; [Yuan, Zuyi] Xi An Jiao Tong Univ, Dept Cardiol, Affiliated Hosp 1, Xian, Peoples R China; [Shi, Hong] Chinese Med Assoc, Beijing, Peoples R China; [Huo, Yong] Peking Univ First Hosp, Dept Cardiol, Beijing, Peoples R China; [Huo, Yong] Peking Univ First Hosp, Dept Cardiol, 8 Xishiku St, Beijing 100191, Peoples R China"

通信作者："Huo, Y (通讯作者)，Peking Univ First Hosp, Dept Cardiol, 8 Xishiku St, Beijing 100191, Peoples R China."

来源：JOURNAL OF MEDICAL INTERNET RESEARCH

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000966192500001

JCR分区：Q1

影响因子：7.4

年份：2022

卷号：24

期号：11

开始页：　

结束页：　

文献类型：Article

关键词：medical priority dispatch system; acute coronary syndrome; prehospital care; emergency medical service; health service; healthcare; health care; coronary; cardiology; cardiovascular

摘要："Background: Acute coronary syndrome (ACS) is the most time-sensitive acute cardiac event that requires rapid dispatching and response. The medical priority dispatch system (MPDS), one of the most extensively used types of emergency dispatch systems, is hypothesized to provide better-quality prehospital emergency treatment. However, few studies have revealed the impact of MPDS use on the process of ACS care. Objective: This study aimed to investigate whether the use of MPDS was associated with higher prehospital diagnosis accuracy and shorter prehospital delay for patients with ACS transferred by an emergency medical service (EMS), using a national database in China. Methods: This retrospective analysis was based on an integrated database of China's MPDS and hospital registry. From January 1, 2016, to December 31, 2020, EMS-treated ACS cases were divided into before MPDS and after MPDS groups in accordance with the MPDS launch time at each EMS center. The primary outcomes included diagnosis consistency between hospital admission and discharge, and prehospital delay. Multivariable logistic regression and propensity score-matching analysis were performed to compare outcomes between the 2 groups for total ACS and subtypes. Results: A total of 9806 ACS cases (3561 before MPDS and 6245 after MPDS) treated by 43 EMS centers were included. The overall diagnosis consistency of the after MPDS group (Cohen kappa=0.918, P<.001) was higher than that of the before MPDS group (Cohen kappa=0.889, P<.001). After the use of the MPDS, the call-to-EMS arrival time was shortened in the matched ACS cases (20.0 vs 16.0 min, P<.001; adjusted difference: -1.67, 95% CI -2.33 to -1.02; P<.001) and in the subtype of ST-elevation myocardial infarction (adjusted difference: -3.81, 95% CI -4.63 to -2.98, P<.001), while the EMS arrival-to-door time (20.0 vs 20.0 min, P=.31) was not significantly different in all ACS cases and subtypes. Conclusions: The optimized use of MPDS in China was associated with increased diagnosis consistency and a reduced call-to-EMS arrival time among EMS-treated patients with ACS. An emergency medical dispatch system should be designed specifically to fit into different prehospital modes in the EMS system on a regional basis. (J Med Internet Res 2022;24(11):e36929) doi: 10.2196/36929"

基金机构：National Natural Science Foundation of China [71904004]; Beijing Natural Science Foundation [9204025]

基金资助正文："This study was supported by the National Natural Science Foundation of China (No. 71904004) , and the Beijing Natural Science Foundation (No. 9204025) ."