The recognition of STEMI by paramedics and the Effect of Computer inTerpretation (RESPECT): a randomised crossover feasibility study
Pilbery, Richard Teare, M. Dawn Goodacre, Steve Morris, Francis
Pilbery, Richard
Teare, M. Dawn
Goodacre, Steve
Morris, Francis
Citations
Altmetric:
Journal Title
Book Title
Publication Volume
Publication Issue
Publication Begin Page
Publication End Page
Publication Number of Pages
Collections
Abstract
Background The appropriate management of patients
with ST-segment elevation myocardial infarction (STEMI)
depends on accurate interpretation of the 12-lead ECG
by paramedics. Computer interpretation messages on
ECGs are often provided, but the effect they exert on
paramedics’ decision-making is not known. The objective
of this study was to assess the feasibility of using an
online assessment tool, and collect pilot data, for a
definitive trial to determine the effect of computer
interpretation messages on paramedics’ diagnosis of
STEMI.
Methods The Recognition of STEMI by Paramedics and
the Effect of Computer inTerpretation (RESPECT)
feasibility study was a randomised crossover trial using a
bespoke, web-based assessment tool. Participants were
randomly allocated 12 of 48 ECGs, with an equal mix of
correct and incorrect computer interpretation messages,
and STEMI and STEMI-mimics. The nature of the
responses required a cross-classified multi-level model.
Results 254 paramedics consented into the study, 205
completing the first phase and 150 completing phase
two. The adjusted OR for a correct paramedic
interpretation, when the computer interpretation was
correct (true positive for STEMI or true negative for
STEMI-mimic), was 1.80 (95% CI 0.84 to 4.91) and
0.58 (95% CI 0.41 to 0.81) when the computer
interpretation was incorrect (false positive for STEMI or
false negative for STEMI-mimic). The intraclass
correlation coefficient for correct computer interpretations
was 0.33 for participants and 0.17 for ECGs, and for
incorrect computer interpretations, 0.06 for participants
and 0.01 for ECGs.
Conclusions Determining the effect of computer
interpretation messages using a web-based assessment
tool is feasible, but the design needs to take clustered
data into account. Pilot data suggest that computer
messages influence paramedic interpretation, improving
accuracy when correct and worsening accuracy when
incorrect.
https://emj.bmj.com/content/emermed/33/7/471.full.pdf
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
http://dx.doi.org/10.1136/emermed-2015-204988