Nicklaus P Ashburn1, Anna C Snavely2, Ryan M Angi3, James F Scheidler4, Remle P Crowe5, Henderson D McGinnis3, Brian C Hiestand3, Chadwick D Miller3, Simon A Mahler3, Jason P Stopyra3. 1. Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America. Electronic address: n.ashburn@wakehealth.edu. 2. Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America; Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, United States of America. 3. Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC, United States of America. 4. Department of Emergency Medicine, West Virginia University, Morgantown, WV, United States of America. 5. ESO Solutions, Austin, TX, United States of America.
Abstract
OBJECTIVE: Delays in care for patients with acute cardiac complaints are associated with increased morbidity and mortality. The objective of this study was to quantify rural and urban differences in prehospital time intervals for patients with cardiac complaints. METHODS: The ESO Data Collaborative dataset consisting of records from 1332 EMS agencies was queried for 9-1-1 encounters with acute cardiac problems among adults (age ≥ 18) from 1/1/2013-6/1/2018. Location was classified as rural or urban using the 2010 United States Census. The primary outcome was total prehospital time. Generalized estimating equations evaluated differences in the average times between rural and urban encounters while controlling for age, sex, race, transport mode, loaded mileage, and patient stability. RESULTS: Among 428,054 encounters, the median age was 62 (IQR 50-75) years with 50.7% female, 75.3% white, and 10.3% rural. The median total prehospital, response, scene, and transport times were 37.0 (IQR 29.0-48.0), 6.0 (IQR 4.0-9.0), 16.0 (IQR 12.0-21.0), and 13.0 (IQR 8.0-21.0) minutes. Rural patients had an average total prehospital time that was 16.76 min (95%CI 15.15-18.38) longer than urban patients. After adjusting for covariates, average total time was 5.08 (95%CI 4.37-5.78) minutes longer for rural patients. Average response and transport time were 4.36 (95%CI 3.83-4.89) and 0.62 (95%CI 0.33-0.90) minutes longer for rural patients. Scene time was similar in rural and urban patients (0.09 min, 95%CI -0.15-0.33). CONCLUSION: Rural patients with acute cardiac complaints experienced longer prehospital time than urban patients, even after accounting for other key variables, such as loaded mileage.
OBJECTIVE: Delays in care for patients with acute cardiac complaints are associated with increased morbidity and mortality. The objective of this study was to quantify rural and urban differences in prehospital time intervals for patients with cardiac complaints. METHODS: The ESO Data Collaborative dataset consisting of records from 1332 EMS agencies was queried for 9-1-1 encounters with acute cardiac problems among adults (age ≥ 18) from 1/1/2013-6/1/2018. Location was classified as rural or urban using the 2010 United States Census. The primary outcome was total prehospital time. Generalized estimating equations evaluated differences in the average times between rural and urban encounters while controlling for age, sex, race, transport mode, loaded mileage, and patient stability. RESULTS: Among 428,054 encounters, the median age was 62 (IQR 50-75) years with 50.7% female, 75.3% white, and 10.3% rural. The median total prehospital, response, scene, and transport times were 37.0 (IQR 29.0-48.0), 6.0 (IQR 4.0-9.0), 16.0 (IQR 12.0-21.0), and 13.0 (IQR 8.0-21.0) minutes. Rural patients had an average total prehospital time that was 16.76 min (95%CI 15.15-18.38) longer than urban patients. After adjusting for covariates, average total time was 5.08 (95%CI 4.37-5.78) minutes longer for rural patients. Average response and transport time were 4.36 (95%CI 3.83-4.89) and 0.62 (95%CI 0.33-0.90) minutes longer for rural patients. Scene time was similar in rural and urban patients (0.09 min, 95%CI -0.15-0.33). CONCLUSION: Rural patients with acute cardiac complaints experienced longer prehospital time than urban patients, even after accounting for other key variables, such as loaded mileage.
Authors: Jason P Stopyra; Anna C Snavely; James F Scheidler; Lane M Smith; Robert D Nelson; James E Winslow; Gregory J Pomper; Nicklaus P Ashburn; Nella W Hendley; Robert F Riley; Lauren E Koehler; Chadwick D Miller; Simon A Mahler Journal: Prehosp Emerg Care Date: 2020-03-03 Impact factor: 3.077
Authors: Pamela L Owens; Marguerite L Barrett; Teresa B Gibson; Roxanne M Andrews; Robin M Weinick; Ryan L Mutter Journal: Ann Emerg Med Date: 2010-01-15 Impact factor: 5.721
Authors: Ezra A Amsterdam; Nanette K Wenger; Ralph G Brindis; Donald E Casey; Theodore G Ganiats; David R Holmes; Allan S Jaffe; Hani Jneid; Rosemary F Kelly; Michael C Kontos; Glenn N Levine; Philip R Liebson; Debabrata Mukherjee; Eric D Peterson; Marc S Sabatine; Richard W Smalling; Susan J Zieman Journal: Circulation Date: 2014-09-23 Impact factor: 29.690
Authors: Karin H Humphries; May K Lee; Mona Izadnegahdar; Min Gao; Daniel T Holmes; Frank X Scheuermeyer; Martha Mackay; Andre Mattman; Eric Grafstein Journal: Acad Emerg Med Date: 2018-02-08 Impact factor: 3.451
Authors: Kristian Kragholm; Di Lu; Karen Chiswell; Hussein R Al-Khalidi; Mayme L Roettig; Matthew Roe; James Jollis; Christopher B Granger Journal: J Am Heart Assoc Date: 2017-10-11 Impact factor: 5.501