We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

It Is Time to Get More Accurate Times to Defibrillation

John A. Stewart, RN, MA
Arch Intern Med. 2009;169(22):2162-2166. doi:10.1001/archinternmed.2009.451.
Text Size: A A A
Published online


The recent article by Chan et al1 finds wide variations in the incidence of delayed defibrillation among hospitals that are not adequately explained by hospital-level factors. The authors assume that these variations represent real differences in hospital performance and call for efforts to identify the approaches of top-performing hospitals so that other facilities may adopt them.

Though the authors' attention to this problem is welcome, using the reported data to identify and emulate hospitals achieving “best practices” is likely to be a waste of time and effort. The problem is that the study was based on the time-interval data from the National Registry of Cardiopulmonary Resuscitation (NRCPR). The NRCPR's time-interval data come from handwritten code records and are rounded to the nearest minute, resulting in clearly invalid aggregate statistics: median times to first defibrillation of 0 minutes2 or 1 minute1 and first quartiles of 0 minutes.1,2 These figures are clearly impossible, representing not only inaccuracy but gross underestimation of the problem of delayed defibrillation. Though the analysis of survival by quartiles indicates that the NRCPR data are not completely random, I believe that more accurate data are both desirable and achievable.

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
[Wearable Automatic External Defibrillators]. Zhongguo Yi Liao Qi Xie Za Zhi 2015;39(6):391-4.
MOVIE MAGIC. JEMS 2016;41(4):18.