Previous studies have shown that mortality reduction with thrombolysis in acute myocardial infarction depends in part on time to thrombolysis, which can be shortened by administering these drugs in the Emergency Department (ED). This study was undertaken to determine the appropriateness of thrombolytic use by Emergency Physicians, and to determine complication rates of ED thrombolysis. / The charts of 137 patients admitted from a tertiary care hospital ED with acute coronary syndromes were assessed for concordance with standard Canadian thrombolytic guidelines, based on a blinded review by two independent assessors. The adjusted Kappa statistic for the overall concordance with the guidelines was 0.85 (95% CI 0.76-0.94). Hierarchical modeling was used to estimate the distribution of physician-specific concordance rates. Complication rates for thrombolysis in the ED were similar to previously reported rates. A logistic regression was also carried out to identify other independent predictors of thrombolysis after controlling for eligibility for thrombolysis; none were found. / The results indicate excellent agreement between Emergency Physicians' clinical decisions regarding thrombolysis and standard Canadian thrombolysis guidelines.
| Identifer | oai:union.ndltd.org:LACETR/oai:collectionscanada.gc.ca:QMM.27906 |
| Date | January 1997 |
| Creators | Schull, Michael. |
| Contributors | Battista, R. N. (advisor) |
| Publisher | McGill University |
| Source Sets | Library and Archives Canada ETDs Repository / Centre d'archives des thèses électroniques de Bibliothèque et Archives Canada |
| Language | English |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Format | application/pdf |
| Coverage | Master of Science (Department of Epidemiology and Biostatistics.) |
| Rights | All items in eScholarship@McGill are protected by copyright with all rights reserved unless otherwise indicated. |
| Relation | alephsysno: 001601563, proquestno: MQ37164, Theses scanned by UMI/ProQuest. |
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