Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota.
J Stroke Cerebrovasc Dis. 2013 Nov;22(8):e610-4. doi: 10.1016/j.jstrokecerebrovasdis.2013.07.039. Epub 2013 Sep 25.
Emergency medical dispatchers represent the first line of communication with a patient, and their decision plays an important role in the prehospital care of stroke. We evaluated the rate and accuracy of stroke diagnosis by dispatchers and its influence in the prehospital care of potential stroke patients.
We analyzed the 2009 National Emergency Medical Services Information System. Study population was based on the diagnosis of stroke made by emergency medical technicians (EMT). This was then divided in those coded as stroke/cerebrovascular accident versus others reported by dispatchers and compared with each other.
In all, 67,844 cases were identified as stroke by EMT, but transportation time was available for 52,282 cases that represented the final cohort. Cases identified as stroke by dispatchers were 27,566 (52.7%). When this group compared with stroke cases not identified by dispatchers, we found that the mean age was significantly higher (71.2 versus 68.6 years, P<.0001); advanced life support was dispatched more frequently (84% versus 72.8%, P<.0001), dispatchers offered help and instructions to the caller more frequently, and they arrived at a facility at a shorter time (41.8 versus 49.8 minutes, P<0001). Sensitivity and specificity for the diagnosis of stroke by dispatchers were 34.61 and 99.46, respectively.
Recognition of symptoms and diagnosis of a potential stroke by dispatchers positively affect the care of patients by decreasing the arrival time to a hospital and providing the highest level of prehospital care possible. Education is needed to increase dispatcher's detection of stroke cases.
急救医疗调度员是与患者进行首次沟通的人员，他们的决策对中风的院前护理起着重要作用。我们评估了调度员对中风的诊断率和准确性及其对潜在中风患者院前护理的影响。
我们分析了 2009 年国家紧急医疗服务信息系统。研究人群基于急救技术员（EMT）做出的中风诊断。然后将其分为调度员编码为中风/脑血管意外的患者与其他报告的患者，并进行比较。
总共确定了 67844 例 EMT 编码的中风病例，但只有 52282 例有可获得的转运时间，这些病例构成了最终队列。调度员识别为中风的病例为 27566 例（52.7%）。当将这个组与调度员未识别为中风的病例进行比较时，我们发现平均年龄明显更高（71.2 岁对 68.6 岁，P<.0001）；更频繁地派出高级生命支持（84%对 72.8%，P<.0001），调度员更频繁地向呼叫者提供帮助和指导，并且他们到达医疗机构的时间更短（41.8 分钟对 49.8 分钟，P<0001）。调度员对中风的诊断的敏感性和特异性分别为 34.61%和 99.46%。
调度员对症状的识别和对潜在中风的诊断积极影响患者的护理，缩短了到达医院的时间，并提供了尽可能高的院前护理水平。需要进行教育以提高调度员对中风病例的检测能力。
