ORIGINAL ARTICLE
Simplifying thrombolysis decisions in patients with left bundle branch block
1 A&E, Musgrove Park Hospital, Taunton, Exeter, UK
2 A&E, Taunton & Somerset Hospital, Parkfield Drive, Taunton, UK
Correspondence to:
Correspondence to:
Dr Adam Reuben
Emergency Department, Royal Devon and Exeter Hospital, Barrack Road, Exeter, UK; adamreuben{at}hotmail.com
Objectives: To redesign and simplify an existing decision algorithm for the management of patients who present to the emergency department with chest pain and left bundle branch block (LBBB) based on the Sgarbossa criteria. To compare its reliability with the current algorithm.
Methods: A simplified algorithm was created and tested against the existing algorithm. Electrocardiograms (ECGs) of patients with LBBB were presented to 10 emergency department doctors with both old and new algorithms a week apart. Six ECGs displayed the relevant criteria for thrombolysis and had proven acute myocardial infarction (AMI) based on a gold standard of enzyme measurements. Subjects were asked whether or not they would thrombolyse a patient presenting with the given ECG using each of the algorithms as a guide.
Results: The new algorithm has demonstrated improvements in terms of an increase in appropriate thrombolysis and a reduction in inappropriate thrombolysis. Specificity for AMI rose from 0.85 to 0.99 and sensitivity from 0.38 to 0.6. 
score showed greater agreement with the gold standard.
Conclusion: Patients with AMI and LBBB have a significantly poorer outcome than those without LBBB. Despite this, thrombolysis is less likely to be given to patients with AMI and LBBB. This study demonstrates that in part this is because of cognitive difficulties using the current algorithm. The proposed proforma addresses these issues and provides a simple tool to aid appropriate treatment in this group of patients.
Abbreviations: AMI, acute myocardial infarction; ECG, electrocardiogram; LBBB, left bundle branch block; MI, myocardial infarction
Keywords: bundle branch block; infarction; sgarbossa; thrombolysis
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This article has been cited by other articles:
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Benger, J R
(2006). Simpler thrombolysis decisions in patients with left bundle branch block.. Emerg. Med. J.
23: 325-325
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- Revision for flow chart - figure 3
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- EMJ Online, 6 Sep 2005 [Full text]
- Simpler thrombolysis decisions in patients with LBBB
- Jonathan R Benger
- EMJ Online, 29 Sep 2005 [Full text]
- LBBB with MI
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- EMJ Online, 10 Jul 2007 [Full text]
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