Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen Medical Center, Göttingen, Germany.
Eur J Emerg Med. 2012 Oct;19(5):292-6. doi: 10.1097/MEJ.0b013e32834ce104.
A correct prehospital diagnosis of emergency patients is crucial as it determines initial treatment, admitting specialty, and subsequent treatment. We evaluated the diagnostic accuracy of emergency physicians.
All patients seen by six emergency physicians staffing the local emergency ambulance and rescue helicopter services during an 8-month period were studied. The ambulance and helicopter physicians had 3 and 4 years, respectively, training in anesthesia and intensive care medicine. The admission diagnoses were compared with the discharge diagnoses for agreement. Time of day of the emergency call, patients' age, and sex, living conditions, and presenting symptoms were evaluated as contributing factors.
Three hundred and fifty-five ambulance and 241 helicopter deployment protocols were analyzed. The overall degree of agreement between initial and discharge diagnoses was 90.1% with no difference attributable to years of experience. The lowest agreement rate was seen in neurological disorders (81.5%), with a postictal state after an unobserved seizure often being diagnosed as a cerebrovascular accident. Inability to obtain a complete medical history (e.g. elderly patients, patients in nursing homes, neurological impairment) was associated with a lower agreement rate between initial and discharge diagnoses (P<0.05).
Medical history, physical examination, ECG, and blood glucose enabled a correct diagnosis in most cases, but some were impossible to resolve without further technical and laboratory investigations. Only a few were definitively incorrect. A detailed medical history is essential. Neurological disorders can present with misleading symptoms and when the diagnosis is not clear it is better to assume the worst case.
正确诊断急诊患者至关重要，因为它决定了初始治疗、收治专科和后续治疗。我们评估了急诊医师的诊断准确性。
在 8 个月期间，研究了在当地急救车和救援直升机服务中值班的六名急诊医师接诊的所有患者。救护车和直升机医生分别接受了 3 年和 4 年的麻醉和重症监护医学培训。将入院诊断与出院诊断进行比较以判断一致性。评估了急诊电话的时间、患者年龄和性别、生活条件和主要症状等因素是否为影响因素。
分析了 355 份救护车和 241 份直升机部署协议。初始诊断与出院诊断的总体一致性为 90.1%，与经验年限无关。诊断一致性最低的是神经系统疾病（81.5%），在未观察到癫痫发作后的癫痫后状态常被误诊为脑血管意外。无法获取完整的病史（例如，老年患者、养老院患者、神经功能障碍）与初始诊断和出院诊断之间的一致性较低有关（P<0.05）。
病史、体检、心电图和血糖检查可使大多数病例得到正确诊断，但有些病例如果不进行进一步的技术和实验室检查则无法解决。只有少数病例的诊断是完全错误的。详细的病史至关重要。神经科疾病可能表现出误导性症状，如果诊断不明确，最好假设最坏的情况。
