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Evaluating disparities affecting time from emergency department door to electrocardiogram in chest pain patients


MOJ Women's Health
Laurie Boge,1,2 Wyatt C,2 Sherman DR,1,3 Cecilia M,1 LX Cubeddu,1,4 Escolar E,1 Goldszer RC,1 Farcy DA1,2

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Abstract

Introduction and Study Objectives: For patients presenting to an emergency department with a chief complaint of chest pain, current American Heart Association guidelines recommend that time from emergency department arrival to completion of electrocardiogram be 10 minutes or less. Prior studies have demonstrated that disparities exist in delays in obtaining electrocardiograms within 10 minutes of arrival and have been attributed to gender, race, age and limited English proficiency. The aim of this study is to evaluate if differences still exist amongst a diverse patient population presenting to a busy urban emergency department with a chief complaint of chest pain.

Methods: This retrospective study looked at 3,419 patients who presented to the Emergency Department from January 2018-December 2018 with any complaint of chest pain during the medical screening examination. Arrival time and time of first electrocardiogram along with age, gender, race, ethnicity and primary language were extracted from electronic health records.

Results: For all patients, the mean time to electrocardiogram was 12.5 minutes (95% CI: 12.1-12.7) and 49.9% of all patients received an electrocardiogram within 10 minutes of arrival. Mean time for those who received an electrocardiogram within 10 min of arrival was 6.7 minutes and for those who received an electrocardiogram after 10 min of arrival was 18.2 minutes. Mean time for men was 11.6 minutes and for women 13.3 minutes (P<0.0001); in addition 54% of men and 44.4% of women had electrocardiogram done within 10 minutes of arrival (P<0.0001). No differences were found with regards to primary language, race or ethnicity of patients. Mean time to electrocardiogram for patients less than 40 years old was 14.6 minutes, which was significantly longer than patients equal or older than 40 years, who’s mean time was 11.9 minutes (p<0.0001). The effect of age was observed across gender, race, ethnicity and primary language spoken by the patients.

Conclusions: Patient presenting to the emergency department with chest pain are subject to several biases that potentially create health disparities. In this study we show that younger patients and women had a delay in time to electrocardiogram showing biases are still an issue.

Keywords

electrocardiogram, correlation coefficient, emergency medicine, medicine physicians, chest pain

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