Gemes G, Fuchs T J, Wildner G, Smolle-Jüttner F M, Smolle J, Stoschitzky K, Prause G
Medizinercorps Graz, Austrian Red Cross, Münzgrabenstrasse 171, 8010 Graz, Austria.
Resuscitation. 2005 Sep;66(3):323-30. doi: 10.1016/j.resuscitation.2005.04.006.
In the Austrian emergency medical service (EMS), emergency medical technician-staffed and physician-staffed vehicles are in operation. Patients with suspected acute coronary syndromes (ACS) are treated in the pre-hospital phase and transported to the hospital by an emergency physician (EP). This study evaluates the diagnostic performance of EPs in ACS and the impact of this emergency system on the outcome of ACS in an urban area.
Retrospective case control study.
All protocol sheets from the emergency physicians were searched for the diagnosis of ACS. The database of the emergency department (ED) was searched for patients with ACS as an admission diagnosis or ACS as discharge diagnosis. For patients admitted to an intensive care unit (ICU), the medical history from the ICU was reviewed. According to the diagnosis and the aggressiveness of therapy, patients were divided in five categories of severity at each stage of care (pre-hospital category, ED category, ICU category).
A total of 3585 patients was analysed. Only 17.8% of the patients with ACS as the admission diagnosis and 20.3% of the patients with ACS as the discharge diagnosis were transported by an EP. 46.8% of the ACS diagnosis by EPs were confirmed in hospital. Patients transported by EPs showed a higher all-cause mortality in hospital (1.6% vs. 0.6%; p=0.011). There was no significant correlation between the pre-hospital category of patients treated by EPs and the ED category. When a 12-lead-electrocardiogram was recorded, the correlation improved slightly (rho: 0.139; p=0.006).
The percentage of ACS patients transported to hospital by an EP is very low, and EPs seem to be "over-aware" in the diagnosis of ACS.
在奥地利紧急医疗服务（EMS）中，配备急救医疗技术员和医生的车辆均在运行。疑似急性冠状动脉综合征（ACS）的患者在院前阶段接受治疗，并由急诊医生（EP）送往医院。本研究评估了急诊医生在ACS诊断方面的表现以及该应急系统对城市地区ACS患者结局的影响。
回顾性病例对照研究。
检索急诊医生的所有病历以查找ACS诊断。在急诊科（ED）数据库中搜索以ACS作为入院诊断或出院诊断的患者。对于入住重症监护病房（ICU）的患者，查阅ICU的病史。根据诊断和治疗的积极程度，在护理的每个阶段（院前类别、ED类别、ICU类别）将患者分为五类严重程度。
共分析了3585例患者。以ACS作为入院诊断的患者中，只有17.8%由急诊医生转运，以ACS作为出院诊断的患者中这一比例为20.3%。急诊医生做出的ACS诊断中有46.8%在医院得到证实。由急诊医生转运的患者在医院的全因死亡率更高（1.6%对0.6%；p=0.011）。急诊医生治疗的患者院前类别与ED类别之间无显著相关性。记录12导联心电图时，相关性略有改善（rho：0.139；p=0.006）。
由急诊医生送往医院的ACS患者比例非常低，而且急诊医生在ACS诊断方面似乎“过度敏感”。
