Foltin George, Markenson David, Tunik Michael, Wellborn Charles, Treiber Marsha, Cooper Arthur
Department of Pediatrics, Bellevue Hospital Center, New York University School of Medicine, New York, New York 10016, USA.
Pediatr Emerg Care. 2002 Apr;18(2):81-5. doi: 10.1097/00006565-200204000-00005.
To determine whether emergency medical technicians-basic can accurately assess children and whether this ability varies with the patient's age or diagnosis. This determination is important for educational program design for emergency medical technicians in pediatrics and for evaluation of the possibility of expanding their scope of practice.
Retrospective chart review.
Pediatric emergency department in a large, urban hospital.
Patients (n = 2430) presenting to the pediatric emergency department via basic life support ambulance during a 12-month period.
Data collected were name, age, field assessment (FA), and emergency department (ED) diagnosis. Patient's ages were organized into five groups: infant (0-1 y), toddler (1-3 y), preschool (3-6 y), school-aged (6-11 y), and adolescent (> 11 y), and the ED diagnoses were divided into seven categories. The accuracy of the FA was compared with the ED diagnosis. We then analyzed FA accuracy by patient's age and type of diagnosis. The chi(2) contingency table analysis was used for dichotomous variables (P < 0.05). In addition, logistic regression and stratified analysis were used. Both ambulance and hospital charts were available for 2064 patients. Age ranged from birth to 19 years with a bimodal distribution at the extremes of patient age and a mean age of 8.25 (SD, 5.64). The distribution was 11.7% (241) infants, 14.7% (303) toddlers, 14.9% (307) preschool, 21.2% (437) school-aged, and 37.6% (776) adolescents.
Overall emergency medical technician-basic assessment was accurate 81.5% (1683) of the time. There was a statistically significant variation in accuracy with both age group (chi(2) = 40.07, P < 0.05) and diagnostic category (chi(2) = 185.7, P < 0.05). By age group, the accuracy of field assessment was 69.7% (168) infants, 75.9% (230) toddlers, 82.7% (254) preschool, 86.7% (379) school-aged, and 84.0% (652) adolescents. By category of diagnosis, the accuracy of the field assessment was 92.4% (292) major trauma, 91.4% (478) minor trauma, 88.9% (112) psychologic and social, 85.1% (229) major medical, 81.1% (180) wheezing-associated respiratory illness, 65.4% (350) minor medical, and 57.5% (42) non-wheezing-associated respiratory illness.
Emergency medical technicians-basic were highly successful in assessing children with wheezing, serious illness, injuries, and psychologic and social conditions. Consideration should be given to expanding their scope of practice in these areas. They were less successful in assessing minor medical conditions and respiratory emergencies other than wheezing. They require additional training in these areas.
确定急救医疗技术员（基础水平）能否准确评估儿童，以及这种能力是否因患者年龄或诊断而异。这一判定对于儿科急救医疗技术员的教育项目设计以及评估扩大其执业范围的可能性具有重要意义。
回顾性病历审查。
一家大型城市医院的儿科急诊科。
在12个月期间通过基础生命支持救护车送至儿科急诊科的患者（n = 2430）。
收集的数据包括姓名、年龄、现场评估（FA）和急诊科（ED）诊断。患者年龄分为五组：婴儿（0 - 1岁）、幼儿（1 - 3岁）、学龄前儿童（3 - 6岁）、学龄儿童（6 - 11岁）和青少年（> 11岁），ED诊断分为七类。将FA的准确性与ED诊断进行比较。然后按患者年龄和诊断类型分析FA准确性。对二分变量采用卡方列联表分析（P < 0.05）。此外，还使用了逻辑回归和分层分析。2064例患者同时有救护车和医院病历。年龄范围从出生到19岁，在患者年龄两端呈双峰分布，平均年龄为8.25（标准差，5.64）。分布情况为：婴儿11.7%（241例）、幼儿14.7%（303例）、学龄前儿童14.9%（307例）、学龄儿童21.2%（437例）、青少年37.6%（776例）。
总体而言，急救医疗技术员（基础水平）评估准确的时间占81.5%（1683例）。准确性在年龄组（卡方 = 40.07，P < 0.05）和诊断类别（卡方 = 185.7，P < 0.05）方面均存在统计学显著差异。按年龄组划分，现场评估的准确性分别为：婴儿69.7%（168例）、幼儿75.9%（230例）、学龄前儿童82.7%（254例）、学龄儿童86.7%（379例）、青少年84.0%（652例）。按诊断类别划分，现场评估的准确性分别为：重大创伤92.4%（292例）、轻度创伤91.4%（478例）、心理和社会问题88.9%（112例）、重大疾病85.1%（229例）、喘息相关呼吸道疾病81.1%（180例）、轻度疾病65.4%（350例）、非喘息相关呼吸道疾病57.5%（42例）。
急救医疗技术员（基础水平）在评估患有喘息、重病、受伤以及心理和社会问题的儿童方面非常成功。应考虑在这些领域扩大其执业范围。他们在评估轻度疾病和除喘息外的呼吸道急症方面不太成功。他们在这些领域需要额外培训。
