1022 - Inclusion | Exclusion Criteria-1022 - Inclusion

Video Transcription

Thank you for joining the Chest Pain MI Registry case scenario for October of 2022, where we will discuss inclusion-exclusion criteria.  An 84-year-old female presents for a mechanical fall with severe right hip pain on Friday evening.  After a thorough examination, hip fracture is diagnosed, and right hip arthroplasty is recommended.  On Sunday, the patient is transferred to the sister hospital for hip arthroplasty surgery, scheduled for Monday morning.  On Wednesday, the patient complains of an acute onset of chest pain. An ECG is obtained and reveals ST elevation.  A STEMI clinical diagnosis is made, and cardiology consult is ordered. Our question is, does this patient meet inclusion criteria for the sister or receiving hospital?  Number one, no, or number two, yes. Please take a few moments to review the scenario, question, and possible answers prior to making your final decision on the best possible answer.  And the answer is number two, yes. The patient meets inclusion criteria as STEMI in-hospital for the receiving hospital.  Let's review the rationale and pertinent information as to why this patient meets inclusion criteria for the sister or receiving hospital.  Per the steering committee, only the clinical diagnosis of STEMI is required to include an in-hospital STEMI into the registry.  There is a disparity in care between those patients who arrive with STEMI and those who develop a STEMI after admission, leading to or resulting in a higher mortality rate.  This is related to delays in diagnosis, the complexity of treatment once diagnosed, and less frequent use of a reperfusion strategy. And some additional information.  The transferring facility information is not relevant to an in-hospital STEMI, and by design,  when an in-hospital is selected in sequence 12447 STEMI type, then sequence 12421 transferred from outside facility will not open to be answered.  The header states complete if patient type is STEMI and STEMI setting is pre-admit, or if patient type is NSTEMI, low-risk chest pain, or unstable angina.  Lastly, the exclusion criteria of transfer patients with time of outside facility sequence 12426 to arrival time sequence 3001 of greater than 24 hours are not included and does not  apply to an in-hospital STEMI. The transfer section of the data collection tool will not open to allow for coding of  sequence 12426, arrival at outside facility date and time, when the patient type is STEMI and the STEMI setting is in-hospital, which is part of the exclusion criteria calculation.  Thank you for reviewing the Chest Pain MI Registry October 2022 case scenario.

Video Summary

In this video, the presenter discusses a case scenario involving an 84-year-old female who initially presented with severe right hip pain due to a fall. The patient was diagnosed with a hip fracture and recommended for right hip arthroplasty. After being transferred to a sister hospital for the surgery, the patient experienced an acute onset of chest pain with ST elevation on an ECG. A diagnosis of STEMI (ST elevation myocardial infarction) was made, and a cardiology consult was ordered. The question posed is whether the patient meets the inclusion criteria for the receiving hospital, and the answer is yes. The presenter explains that the clinical diagnosis of STEMI is sufficient to include the patient in the registry. Factors leading to a higher mortality rate in in-hospital STEMI cases are also discussed, including delays in diagnosis and treatment complexity. The video concludes by stating that certain exclusion criteria related to transfer patients do not apply to in-hospital STEMI cases.

Keywords

84-year-old female

hip fracture

right hip arthroplasty

STEMI

in-hospital STEMI cases