Afzalimoghadam Mohammad, Mozafari Javad, Talebian Mohammad Taghi, Mohammadnejad Esmaeil, Kasaeian Amir
Department of Emergency Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Acta Med Iran. 2013 Aug 7;51(7):501-5.
This was a prospective cross-sectional study of consecutive transported patients by emergency medical service (EMS) to a referral hospital. The goal of this study was the evaluation of emergency medical technician intermediate prediction about their transported patients disposition in Emergency Department of Imam Khomeini Hospital. 2950 patients were transported to this hospital, Questionnaires were submitted in 300 of consecutive patient transports and completed data were obtained and available upon arrival at hospital for 267 of these cases. Emergency medical technicians intermediate (EMT-I) were asked to predict whether the transported patient would require admission to the hospital, and if so, what will be their prediction of patient actual disposition. Their predictions were compared with emergency specialist physicians. EMT-I predicted that 208 (78%) transports would lead to admission to the hospital, after actual disposition, 232 (%87) patients became admitted. The sensitivity of predicting any admission was 65%, with positive predictive value (PPV) of 39% and specificity of 86% with negative predictive value (NPV) of 94%. The sensitivity of predicting trauma patients (56.2% of total patients) was 55% with PPV of 38%, specificity of 86% and for Non-trauma patients' sensitivity was 80% with PPV of 40% and specificity of 82%. EMT-I in our emergency medical system have very limited ability in prediction of admission and disposition in transported patients and their prediction were better in Non-trauma patients. So in our EMS, the pre-hospital diversion and necessity of transporting policies should not be based on EMS personnel disposition.
这是一项对通过紧急医疗服务（EMS）连续转运至一家转诊医院的患者进行的前瞻性横断面研究。本研究的目的是评估中级急救医疗技术人员对他们转运至伊玛目霍梅尼医院急诊科的患者处置情况的预测。2950名患者被转运至该医院，在连续300次患者转运中发放了问卷，其中267例在到达医院时获得了完整数据。中级急救医疗技术人员（EMT-I）被要求预测所转运的患者是否需要住院治疗，如果需要，他们对患者实际处置情况的预测是什么。他们的预测与急诊专科医生的预测进行了比较。EMT-I预测208例（78%）转运患者将住院，而实际处置后，232例（87%）患者入院。预测任何患者住院的敏感性为65%，阳性预测值（PPV）为39%，特异性为86%，阴性预测值（NPV）为94%。预测创伤患者（占总患者的56.2%）的敏感性为55%，PPV为38%，特异性为86%；对于非创伤患者，敏感性为80%，PPV为40%，特异性为82%。我们紧急医疗系统中的EMT-I在预测转运患者的住院和处置情况方面能力非常有限，他们对非创伤患者的预测更好。因此，在我们的EMS中，院前分流和转运政策的必要性不应基于EMS人员的处置情况。
