医疗投诉的急救医疗调度代码预测院前高级生命支持干预措施的能力。

The ability of emergency medical dispatch codes of medical complaints to predict ALS prehospital interventions.

作者信息

Sporer Karl A, Youngblood Glen M, Rodriguez Robert M

机构信息

Department of Medicine, University of California, San Francisco, USA.

出版信息

Prehosp Emerg Care. 2007 Apr-Jun;11(2):192-8. doi: 10.1080/10903120701205984.

DOI:10.1080/10903120701205984

PMID:17454806

Abstract

OBJECTIVE

The Medical Priority Dispatch System (MPDS) is an emergency medical dispatch (EMD) system that is commonly used to triage 9-1-1 calls and optimize paramedic and EMT dispatch. The objective of this study was to determine the sensitivity, specificity, and positive and negative predictive values of selected MPDS dispatch codes to predict the need for ALS medication or procedures.

METHODS

Patients with selected MPDS codes between November 1, 2003, and October 31, 2005, from a suburban California county were matched with their electronic patient care record. The records of all transported patients were queried for prehospital interventions and matched to their MPDS classification [Basic Life Support (BLS) versus Advanced Life Support (ALS)]. Patients who received prehospital interventions or medications were considered ALS Intervention. With true positive = ALS by MPDS + ALS Intervention, true negative = BLS by MPDS + BLS Interventions, false positive = ALS by MPDS + BLS Interventions, and false negative = BLS by MPDS + ALS Interventions, the screening performance of the San Mateo County EMD system was determined for selected complaint categories (abdominal pain, breathing problems chest pain, sick person, seizures, and unconscious/fainting).

RESULTS

There were a total of 64,647 medical calls, and 42,651 went through the EMD process; 31,187 went through the EMD process and were transported; 22,243 of these were matched to a patient care record. The sensitivity and specificity with 95% confidence intervals in () were as follows: all EMD calls 84 (83-85), 36 (35-36); abdominal pain, 53 (41-65), 47 (43-51); chest pain 99 (99-100), 2 (1-3); seizure 83 (77-88), 20 (17-23), sick 59 (53-64), 51 (49-54), and unconscious/fainting 99 (98-100), 2 (2-3).

CONCLUSION

In our EMS system, MPDS coding for all medical calls had high sensitivity and low specificity for the prediction of calls that required ALS intervention. Chest pain and unconscious/fainting calls were screened with very high sensitivity but very low specificity.

摘要

目的

医疗优先调度系统（MPDS）是一种紧急医疗调度（EMD）系统，常用于对911呼叫进行分诊并优化护理人员和急救医疗技术员的调度。本研究的目的是确定所选MPDS调度代码预测是否需要高级生命支持（ALS）药物或程序的敏感性、特异性以及阳性和阴性预测值。

方法

将2003年11月1日至2005年10月31日期间来自加利福尼亚州一个郊区县、具有所选MPDS代码的患者与其电子患者护理记录进行匹配。查询所有转运患者的记录，以获取院前干预措施并将其与MPDS分类（基础生命支持[BLS]与高级生命支持[ALS]）进行匹配。接受院前干预或药物治疗的患者被视为接受了ALS干预。真阳性定义为MPDS判断为ALS且接受了ALS干预，真阴性定义为MPDS判断为BLS且接受了BLS干预，假阳性定义为MPDS判断为ALS但接受了BLS干预，假阴性定义为MPDS判断为BLS但接受了ALS干预，据此确定圣马特奥县EMD系统对所选投诉类别（腹痛、呼吸问题、胸痛、患者不适、癫痫发作以及昏迷/昏厥）的筛查性能。

结果

共有64647次医疗呼叫，其中42651次经过了EMD流程；31187次经过EMD流程并被转运；其中22243次与患者护理记录相匹配。括号内为95%置信区间的敏感性和特异性如下：所有EMD呼叫，84（83 - 85），36（35 - 36）；腹痛，53（41 - 65），47（43 - 51）；胸痛，99（99 - 100），2（1 - 3）；癫痫发作，83（77 - 88），20（17 - 23），患者不适，59（53 - 64），51（49 - 54），以及昏迷/昏厥，99（98 - 100），2（2 - 3）。