Please cite this article in press as: Frisch A, et al. Documentation discrepancies of time-dependent critical events in out of hospital cardiac arrest. Resuscitation (2014), http://dx.doi.org/10.1016/j.resuscitation.2014.05.002 ARTICLE IN PRESS G Model RESUS 5990 1–4 Resuscitation xxx (2014) xxx–xxx Contents lists available at ScienceDirect Resuscitation j ourna l h o me pa g e : www.elsevier.com/locate/resuscitation Short communication Documentation discrepancies of time-dependent critical events in out of hospital cardiac arrest  Adam Frisch a,∗ , Joshua C. Reynolds b , Joseph Condle c , Danielle Gruen c , Q1 Clifton W. Callaway c a Department of Emergency Medicine, Albany Medical Center Hospital, Albany, NY United States Q2 b Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI United States c Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA United States a r t i c l e i n f o Article history: Received 1 March 2014 Received in revised form 16 April 2014 Accepted 1 May 2014 Keywords: Cardiac arrest Resuscitation Time a b s t r a c t Objectives: The timing of and interval between events in prehospital care is important for system design, patient outcome, and prehospital research. Since these data can guide treatment recommendations, it is imperative that time-based prehospital documentation is accurate and precise, especially for time- sensitive conditions such as out-of-hospital cardiac arrest (OHCA). We compared the times of select events documented in the medical record (PCR) with times from time-stamped audio recordings in the monitor-defibrillator (AUD). Methods: A retrospective cohort of prehospital, adult, atraumatic OHCA resuscitations from two regional EMS agencies over a 10-month period was performed. Primary outcome was absolute difference (min- utes) between PCR and AUD documented times for select events during OHCA resuscitation (IV access, IO access, first epinephrine administration, supraglottic airway insertion, endotracheal intubation, and return of spontaneous circulation). We describe the magnitude and direction of differences, and estimate the potential error in time intervals abstracted from the medical record. Results: Of 411 patients treated by EMS, 192 had complete data for ≥1 event and 136 had complete data for ≥2 events. 422 total events were identifiable in both PCR and AUD. Median absolute time discrep- ancy between PCR and AUD was 2 (IQR 1–4) min. Median differences between the smallest and largest PCR–AUD discrepancy was 2 (IQR 1–4.5) min. Discrepancies were both positive and negative, and not consistent within individual records. Conclusion: We found a 2 (IQR 1–4) min imprecision in the documented timing of select events during OHCA resuscitation. This imprecision contributes to uncertainty in analyses that incorporate time- stamped variables. © 2014 Published by Elsevier Ireland Ltd. 1. Introduction Many interventions and patient-related events occur in the pre- hospital environment. The timing of, and interval between, some events and interventions is important for system design and patient outcome. These can be described as ‘critical events’. As prospec- tively deploying independent observers is usually not feasible, most prehospital research on critical events relies on the prehospital  A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2014.05.002. ∗ Corresponding author at: 47, New Scotland Avenue, Albany, NY 12208, United States. Tel.: +1 518 262 3773; fax: +1 518 262 3236. E-mail address: frischa@mail.amc.edu (A. Frisch). medical record for data collection. In fact, the medical record time of certain critical events, or the documented time interval between critical events, is the usual variable incorporated into analysis. These data can change care guidelines or result in new treatment recommendations. Thus, it is imperative that time-based prehospital documentation is both accurate and precise. However, the prehospital environment poses unique challenges in simulta- neously managing patient care, providing safe transportation, and ensuring accurate documentation, all with limited resources and personnel. Out-of-hospital cardiac arrest (OHCA) is one time-sensitive dis- ease that necessitates specialized care and rapid intervention. Critical events for OHCA include recognition of unresponsiveness, notification of the emergency dispatch system, arrival of prehospi- tal providers, initiation of basic life support, procedures performed, http://dx.doi.org/10.1016/j.resuscitation.2014.05.002 0300-9572/© 2014 Published by Elsevier Ireland Ltd. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43