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SAEM Western Regional 2012 - Walk In STEMI

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Information about SAEM Western Regional 2012 - Walk In STEMI
Health & Medicine

Published on March 3, 2014

Author: GarrenLow

Source: slideshare.net

Description

Society for Academic Emergency Medicine Western Regional 2012:
"Ethnic Disparities in the Utilization of EMS Resources and the Impact on Door-To-PCI Times in STEMI Patients"
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SAEM Western Regional Meeting, March 17, 2012 Garren M.I. Low, MS LAC+USC Medical Center Los Angeles, CA

Ethnic Disparities in the Utilization of EMS Resources and the Impact on Door-ToPCI Times in STEMI Patients Nick Testa, M.D.; Garren Low, MS; David Shavelle, M.D.; Stephanie Hall, M.D.; Kim Newton, M.D.; Linda Chan, Ph.D.

Background     LAC+USC is a STEMI Receiving Center (since January 2008) National standard for Door-to-PCI time is ≤90 minutes Previous research from LAC+USC showed Hispanics have disproportionately long Doorto-PCI time Hispanic-Americans STEMI patients have been shown to have poorer times and outcomes in the literature

Methods  All patients treated for STEMI at LAC+USC   January 2009 – June 2011 Data prospectively collected by cross trainedCCU nurses: “STEMI Nurses”  Data cleaned by Project Coordinator & Biostatistics staff

Results  494 patients over this time period     276 (56%) Hispanic 95 (19%) African American 64 (13%) Asian 59 (12%) Caucasian

Results: % of cases with Door-To-PCI time ≤90 Minutes EMS Walk-In Subtotal Hispanics 55/60 (92%) 48/77 (62%) 103/137 (75%) African Americans 20/21(95%) 1/4 (25%) 21/25 (84%) Subtotal 75/81 (92%) 49/81 (60%) 124/162 (77%)  Crude Odds Ratio (Hispanic vs. AA)   0.58 (95%CI: 0.16, 1.95; p=0.48) Adjusted Odds Ratio (Hispanic vs. AA)  1.54 (95%CI: 0.33, 6.63; p=0.80)

Results: EMS Utilization   African American STEMI Patients utilized EMS 70% of the time Hispanic STEMI Patients utilized EMS 40% of the time

Discussion  The reverse relationship between the Crude Odds Ratio and Adjusted Odds ratio  Suggests that there is an interaction between Entry Mode (EMS Utilization) and the Door-to-PCI time, as viewed by ethnicity

Conclusion   Significant difference between EMS and Walk-In STEMI patients’ Door-to-PCI times No significant difference between African American and Hispanic STEMI patients after adjusting for EMS utilization.

Limitations  Data is from one medical center   Small sample size   Population is multicultural, urban Paper will look at a longer time period No adjustment for patient co-morbidities

No Conflicts of Interest

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