对急诊医疗服务中风预案和现场时间的评估。
An evaluation of emergency medical services stroke protocols and scene times.
机构信息
Received May 15, 2013 from the Departments of Epidemiology (MDP, KRE, WDR) and Biostatistics (CMS), Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; the Department of Emergency Medicine (JHB, CM), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and SRA International (KMR), Durham, North Carolina. Revision received June 14, 2013; accepted for publication June 20, 2013.
出版信息
Prehosp Emerg Care. 2014 Jan-Mar;18(1):15-21. doi: 10.3109/10903127.2013.825354. Epub 2013 Sep 12.
BACKGROUND
Acute stroke patients require immediate medical attention. Therefore, American Stroke Association guidelines recommend that for suspected stroke cases, emergency medical services (EMS) personnel spend less than 15 minutes on-scene at least 90% of the time. However, not all EMS providers include specific scene time limits in their stroke patient care protocols.
OBJECTIVE
We sought to determine whether having a protocol with a specific scene time limit was associated with less time EMS spent on scene. Methods. Stroke protocols from the 100 EMS systems in North Carolina were collected and abstracted for scene time instructions. Suspected stroke events occurring in 2009 were analyzed using data from the North Carolina Prehospital Medical Information System. Scene time was defined as the time from EMS arrival at the scene to departure with the patient. Quantile regression was used to estimate how the 90th percentile of the scene time distribution varied by systems with protocol instructions limiting scene time, adjusting for system patient volume and metropolitan status.
RESULTS
In 2009, 23 EMS systems in North Carolina had no instructions regarding scene time; 73 had general instructions to minimize scene time; and 4 had a specific limit for scene time (i.e., 10 or 15 min). Among 9,723 eligible suspected stroke events, mean scene time was 15.9 minutes (standard deviation 6.9 min) and median scene time was 15.0 minutes (90th percentile 24.3 min). In adjusted quantile regression models, the estimated reduction in the 90th percentile scene time, comparing protocols with a specific time limit to no instructions, was 2.2 minutes (95% confidence interval 1.3, 3.1 min). The difference in 90th percentile scene time between general and absent instructions was not statistically different (0.7 min [95% confidence interval -0.1, 1.4 min]).
CONCLUSION
Protocols with specific scene time limits were associated with EMS crews spending less time at the scene while general instructions were not. These findings suggest EMS systems can modestly improve scene times for stroke by specifying a time limit in their protocols.
背景
急性中风患者需要立即进行医疗救治。因此，美国中风协会的指南建议，对于疑似中风病例，紧急医疗服务（EMS）人员在现场的时间应至少 90%的情况下不超过 15 分钟。然而，并非所有的 EMS 提供者都在其中风患者护理方案中包含具体的现场时间限制。
目的
我们旨在确定是否存在具有特定现场时间限制的方案与 EMS 在现场花费的时间减少有关。方法：收集了北卡罗来纳州 100 个 EMS 系统的中风方案，并对现场时间指示进行了摘要。使用来自北卡罗来纳州院前医疗信息系统的数据，分析了 2009 年发生的疑似中风事件。现场时间定义为 EMS 到达现场到离开现场带着患者的时间。使用分位数回归来估计 90%的现场时间分布如何因具有限制现场时间的方案指示的系统而变化，调整了系统患者量和城市地位。
结果
2009 年，北卡罗来纳州的 23 个 EMS 系统没有关于现场时间的指示；73 个系统有最小化现场时间的一般指示；4 个系统有现场时间的具体限制（即 10 或 15 分钟）。在 9723 例符合条件的疑似中风事件中，平均现场时间为 15.9 分钟（标准差 6.9 分钟），中位数现场时间为 15.0 分钟（90%分位数为 24.3 分钟）。在调整后的分位数回归模型中，与没有指示相比，具有特定时间限制的方案估计减少了 90%分位数的现场时间为 2.2 分钟（95%置信区间 1.3,3.1 分钟）。一般指示和无指示之间 90%分位数现场时间的差异没有统计学意义（0.7 分钟[95%置信区间 -0.1,1.4 分钟]）。
结论
具有特定现场时间限制的方案与 EMS 人员在现场花费的时间减少有关，而一般指示则没有。这些发现表明，EMS 系统可以通过在其方案中指定时间限制，适度地提高中风患者的现场时间。
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