Williams Teresa A, Finn Judith, Fatovich Daniel, Perkins Gavin D, Summers Quentin, Jacobs Ian
Prehosp Emerg Care. 2015;19(4):535-43. doi: 10.3109/10903127.2014.995841. Epub 2015 Feb 9.
Separate clinical practice guidelines (CPG) for asthma and chronic obstructive pulmonary disease (COPD) often guide prehospital care. However, having distinct CPGs implies that paramedics can accurately differentiate these conditions. We compared the accuracy of paramedic identification of these two conditions against the emergency department (ED) discharge diagnosis.
A retrospective cohort of all patients transported to ED by ambulance in Perth, Western Australia between July 2012 and June 2013; and identified as "asthma" or "COPD" by paramedics. We linked ambulance data to emergency department discharge diagnosis.
Of 1,067 patients identified by paramedics as having asthma, 41% had an ED discharge diagnosis of asthma, i.e., positive predictive value (PPV) = 41% (95% CI 38-44%). Of 1,048 patients recorded as COPD, 57% had an ED discharge diagnosis of COPD (PPV 57%; 95% CI 54-60%). Sensitivity for the paramedic identification of patients diagnosed with asthma or COPD in the ED was 66% for asthma (95% CI 63-70%) and 39% for COPD (95% CI 36-41%). Paramedics reported wheezing in 86% of asthma and 55% of COPD patients.
Differentiating between asthma and COPD in the prehospital setting is difficult. A single CPG for respiratory distress would be more useful for the clinical management of these patients by paramedics.
哮喘和慢性阻塞性肺疾病（COPD）的独立临床实践指南（CPG）常常指导院前急救。然而，拥有不同的CPG意味着护理人员能够准确区分这些病症。我们将护理人员对这两种病症的识别准确性与急诊科（ED）出院诊断进行了比较。
对2012年7月至2013年6月期间在西澳大利亚州珀斯由救护车转运至ED的所有患者进行回顾性队列研究；并由护理人员确定为“哮喘”或“COPD”。我们将救护车数据与急诊科出院诊断相关联。
护理人员确定为患有哮喘的1067例患者中，41%的患者出院诊断为哮喘，即阳性预测值（PPV）=41%（95%可信区间38 - 44%）。记录为COPD的1048例患者中，57%的患者出院诊断为COPD（PPV 57%；95%可信区间54 - 60%）。护理人员识别ED中诊断为哮喘或COPD患者的敏感性，哮喘为66%（95%可信区间63 - 70%），COPD为39%（95%可信区间36 - 41%）。护理人员报告86%的哮喘患者和55%的COPD患者有喘息症状。
在院前环境中区分哮喘和COPD很困难。单一的呼吸窘迫CPG对护理人员对这些患者的临床管理会更有用。
