• Symptoms of Myocardial Infarction: Concordance between Paramedic and Hospital Records

    by Alan Batt. Last modified: 16/04/14



    Coventry LL, Bremner AP, Williams TA, Jacobs IG, Finn J. Symptoms of Myocardial Infarction: Concordance between Paramedic and Hospital Records. Prehosp Emerg Care. 2014 Mar 26. PMID: 24669962.


    • Retrospective review of records with ED diagnosis of MI
    • 810 patients with diagnosis of AMI from ED
      • 584 arrived by ambulance
      • 400 had PCR and medical records available
      • Chest pain  as a symptom had sensitivity, specificity, PPV, and NPV all over 85%
    • Documentation of the common symptoms of MI and symptom-onset time was similar between paramedic and hospital records


    • Single site (hospital and EMS)
    • Retrospective review of prospectively collected data
    • ED diagnosis was taken as accurate, did not take into account further in-patient testing and diagnoses



    To further reduce time to definitive therapy for acute myocardial infarction (MI) patients, the focus of research needs to be on better understanding prehospital delay in recognition and response to symptoms. Paramedic clinical records can serve as a convenient source of data for such studies, but their accuracy needs to be established.


    This study aimed to determine the concordance of the symptoms and symptom-onset time recorded in the paramedic patient care record (PCR) with those recorded in the hospital medical record for MI patients.


    A retrospective review of paramedic and hospital medical records was undertaken between January 1, 2008 and October 31, 2009 for all patients with an emergency department (ED) discharge diagnosis of MI at a single teaching hospital in Perth, Western Australia. The symptoms of MI and onset times documented in the paramedic PCR were compared with those recorded in the hospital medical record, which was considered the “gold standard.” The study assessed differences in documentation using McNemar’s tests, and concordance was described by kappa and adjusted kappa statistics, sensitivity, specificity, and positive and negative predictive value (PPV, NPV).


    Of 810 patients with an ED discharge diagnosis of MI, 584 (71%) patients arrived by ambulance and 509 patients had a paramedic PCR. After exclusions, 400 patients had both paramedic PCR and hospital medical records available for review. Of 21 documented MI symptoms, the majority (71.4%) had adjusted kappa statistics greater than 0.75, and observed agreement greater than 90%. For the symptom of chest pain, sensitivity, specificity, PPV, and NPV were all over 85%. Where recorded in both records (n = 196, 49%) the symptom-onset time agreed exactly for 118 (60.2%) records, differed by 1-15 minutes for 24 (12.2%) records, and differed by 16-30 minutes for 22 (11.2%) records.


    Our study demonstrated that documentation of the common symptoms of MI and symptom-onset time was similar between the paramedic and hospital records, justifying the use of paramedic PCRs as a source of data for research in prehospital MI patient delay. Further research is required to investigate why symptom-onset time was not routinely documented for all patients with chest pain.

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    Alan Batt

    Alan Batt

    Paramedic, educator, researcher
    Alan is a critical care paramedic, paramedic educator and prehospital researcher, currently working around the world as an educator and researcher. He has previously worked and studied across Europe, North America and the Middle East. He holds a Graduate Certificate in Intensive Care Paramedic Studies, and an MSc in Critical Care. His main interests are in care of the elderly, end-of-life care, patient safety, professionalism (including role and identity), and paramedic education.

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