紧急医疗调度员和护理人员对中风识别的准确性——圣地亚哥的经验
Accuracy of stroke recognition by emergency medical dispatchers and paramedics--San Diego experience.
作者信息
Ramanujam Prasanthi, Guluma Kama Z, Castillo Edward M, Chacon Marcus, Jensen Matt B, Patel Ekta, Linnick William, Dunford James V
机构信息
Department of Emergency Medicine, University of San Francisco Medical Center, San Francisco, CA 94143-0208, USA.
出版信息
Prehosp Emerg Care. 2008 Jul-Sep;12(3):307-13. doi: 10.1080/10903120802099526.
BACKGROUND
Prehospital personnel in Emergency Medical Service (EMS) systems have varying levels of accuracy in stroke recognition. Identifying the accuracy of emergency medical dispatcher using Medical Priority Dispatch Systems (MPDS) stroke protocol and paramedics may help understand the accuracy of stroke recognition in about 3000 emergency medical dispatch systems and prehospital systems world wide.
OBJECTIVE
Our aim was to assess the accuracy of stroke identification in emergency medical dispatchers (EMD) with high compliance to MPDS protocol and paramedics using Cincinnati Prehospital Stroke Scale (CSS).
METHODS
This was a retrospective observational study. Data was acquired from a computer assisted dispatch (CAD) system, a computerized paramedic record database and discharge diagnosis from billing records or stroke registry containing all stroke assessments of patients who presented to the participating study hospitals within 12 hours of symptom onset. We included patients 18 years or older, identified as having stroke by EMD and city agency paramedics. We excluded patients taken to hospitals not participating in the study, patients with a dispatch determinant of Stroke (card 28) not transported by City EMS agency (SDMSE) to participating hospitals, patients in the stroke registry not transported by SDMSE or patients with no final outcome data. A stroke neurologist or hospital discharge diagnosis of stroke (physician diagnosis) was used to determine the sensitivity and predictive values of EMD and paramedic recognition of stroke.
RESULTS
Of 882 patients with a dispatch determinant of stroke using MPDS Stroke protocol, 367 had a final discharge diagnosis of stroke. This gives a sensitivity of 83% and a positive predictive value of 42% for EMD using MPDS Stroke protocol. Of 477 patients with a paramedic assessment of stroke using CSS, 193 had a final discharge diagnosis of stroke. This gives a sensitivity of 44% and a PPV of 40% for paramedics using CSS.
CONCLUSIONS
In our EMS system, EMD using MPDS Stroke protocol with a high compliance has a higher sensitivity than paramedics using CSS.
背景
紧急医疗服务（EMS）系统中的院前急救人员对中风的识别准确率各不相同。确定使用医疗优先调度系统（MPDS）中风协议的紧急医疗调度员和护理人员的准确率，可能有助于了解全球约3000个紧急医疗调度系统和院前系统中中风识别的准确率。
目的
我们的目的是评估高度遵守MPDS协议的紧急医疗调度员（EMD）以及使用辛辛那提院前中风量表（CSS）的护理人员对中风识别的准确率。
方法
这是一项回顾性观察研究。数据来自计算机辅助调度（CAD）系统、计算机化护理人员记录数据库以及计费记录或中风登记处的出院诊断，其中包含症状发作后12小时内送往参与研究医院的所有患者的中风评估。我们纳入了18岁及以上、被EMD和城市机构护理人员确定为中风的患者。我们排除了被送往未参与研究医院的患者、调度决定为中风（卡片28）但未由城市EMS机构（SDMSE）送往参与医院的患者、中风登记处中未由SDMSE运送的患者或没有最终结局数据的患者。由中风神经科医生或医院出院诊断为中风（医生诊断）来确定EMD和护理人员对中风识别的敏感性和预测值。
结果
在882例使用MPDS中风协议调度决定为中风的患者中，367例最终出院诊断为中风。这使得使用MPDS中风协议的EMD的敏感性为83%，阳性预测值为42%。在477例使用CSS进行护理人员中风评估的患者中，193例最终出院诊断为中风。这使得使用CSS的护理人员的敏感性为44%，PPV为40%。
结论
在我们的EMS系统中，高度遵守MPDS中风协议的EMD比使用CSS的护理人员具有更高的敏感性。
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