The following are the incidence of various cardiac rhythms as determined by the treating Paramedic for an ALS ambulance from October 2007 to June 2012. Outlier data were examined for correctness, including all interpretations of rhythms with less than 2% incidence. Incomplete data for each record was added if available, otherwise the record was ignored. AV Nodal Blocks and Bundle Branch Blocks were not recorded in this data set.
- Patients: 3528 (47% male)
- Age: 8 hours - 110 years (avg 56 yr, median 60 yr)
- First Contact Heart Rate (>0): 22-260 bpm (avg 91 bpm, median 90 bpm, stdev 29.5)
- First Contact Rhythm:
| Count | Rhythm | |
|---|---|---|
| 1841 | 52.18% | Normal Sinus Rhythm |
| 995 | 28.20% | Sinus Tachycardia |
| 145 | 4.11% | Paced Rhythm |
| 139 | 3.94% | Sinus Bradycardia |
| 114 | 3.23% | Atrial Fibrillation |
| 88 | 2.49% | Asystole |
| 68 | 1.93% | Sinus Arrhythmia |
| 67 | 1.90% | Atrial Fibrillation w/ RVR |
| 19 | 0.54% | Pulseless Electrical Activity |
| 18 | 0.51% | Supraventricular Tachycardia |
| 11 | 0.31% | Ventricular Fibrillation |
| 10 | 0.28% | Atrial Flutter |
| 5 | 0.14% | Ventricular Tachycardia |
| 4 | 0.11% | Junctional Rhythm |
| 2 | 0.06% | Idioventricular Rhythm |
| 1 | 0.03% | Ectopic Atrial Tachycardia |
| 1 | 0.03% | Junctional Tachycardia |
Incidence of paced rhythm > SB and AF! That is surprising to me and very interesting; what is particularly thought provoking is how this incidence data would compare to that of other geographical regions with different demographics (eg. economic, access to insurance, access to care, proximity to university med. cen., ethnic, educational, etc.).
ReplyDeleteAlso, how does the incidence based on paramedic/ prehospital dx reflect the incidence in the general population as determined by MD dx (excluding morbid rhythms), or how does pre-hospital dx reflect ED dx? Where are the disparities, and why?
Thanks for making me think about this stuff!
Our population is older (2 nursing homes introduce bias) and less insured (low median income).
ReplyDeleteIf you include AF w/ RVR then atrial fibrillation has a higher incidence than paced rhythms.
I did find it interesting that sinus brady was lower in incidence, but perhaps that is due to sampling bias: patients that paramedics decide to place on the cardiac monitor.
My favorite was the median heart rate! Ambulatory holter monitoring usually shows a rate in the mid 70's or mid 60's depending on the age group.
I just wanted to see how prevalent dysrhythmias were for a single ambulance, and I enjoyed it!
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