Brandler Ethan S, Sharma Mohit, McCullough Flynn, Ben-Eli David, Kaufman Bradley, Khandelwal Priyank, Helzner Elizabeth, Sinert Richard H, Levine Steven R
Department of Emergency Medicine, State University of New York at Stony Brook, Stony Brook, New York; Department of Emergency Medicine, State University of New York Downstate Medical Center, Brooklyn, New York.
Department of Neurology, State University of New York Downstate Medical Center, Brooklyn, New York.
J Stroke Cerebrovasc Dis. 2015 Sep;24(9):2161-6. doi: 10.1016/j.jstrokecerebrovasdis.2015.06.004. Epub 2015 Jul 7.
Stroke patients misdiagnosed by emergency medical services (EMS) providers have been shown to receive delayed in-hospital care. We aim at determining the diagnostic accuracy of Fire Department of New York (FDNY) EMS providers for stroke and identifying potential reasons for misdiagnosis.
Prehospital care reports of all patients transported by FDNY EMS to 3 hospitals from January 1, 2010, to December 31, 2011, were compared against the American Heart Association Get With The Guidelines (GWTG) database (reference standard) for the diagnosis of stroke. Age-adjusted logistic regression models were generated to explore prehospital patient characteristics which are associated with stroke misdiagnosis.
Of 72,984 patient transports during the study period, 750 had a GWTG diagnosis of stroke, 468 (62%) of which were identified correctly in the field and 282 (38%) were missed. An additional 268 patients were misdiagnosed as stroke when in fact they had an alternative diagnosis. Overall sensitivity was 62.4% (95% confidence interval [CI], 58.9-65.8) and specificity was 99.6% (95% CI, 99.6-99.7). No patients who presented with unilateral weakness, facial weakness, or speech problems were missed, whereas patients with atypical complaints like general malaise, dizziness, and headache were more likely to be missed. Seizures led the EMS providers to both overcall a stroke and miss the diagnosis.
FDNY EMS care providers missed more than a third of stroke cases. Seizures and other atypical presentations contribute significantly to stroke misdiagnosis in the field. Our findings highlight the need for better prehospital stroke identification methods.
已有研究表明，被紧急医疗服务（EMS）人员误诊的中风患者在医院接受治疗的时间会延迟。我们旨在确定纽约消防局（FDNY）的EMS人员对中风的诊断准确性，并找出误诊的潜在原因。
将2010年1月1日至2011年12月31日期间由FDNY的EMS送往3家医院的所有患者的院前护理报告与美国心脏协会“遵循指南”（GWTG）数据库（参考标准）进行比较，以诊断中风。生成年龄调整后的逻辑回归模型，以探索与中风误诊相关的院前患者特征。
在研究期间的72984次患者转运中，有750例在GWTG数据库中被诊断为中风，其中468例（62%）在现场被正确识别，282例（38%）被漏诊。另外有268例患者实际上有其他诊断，但被误诊为中风。总体敏感性为62.4%（95%置信区间[CI]，58.9 - 65.8），特异性为99.6%（95%CI，99.6 - 99.7）。没有出现单侧无力、面部无力或言语问题的患者被漏诊，而出现全身不适、头晕和头痛等非典型症状的患者更容易被漏诊。癫痫发作导致EMS人员既过度诊断中风又漏诊。
FDNY的EMS护理人员漏诊了超过三分之一的中风病例。癫痫发作和其他非典型表现是现场中风误诊的重要原因。我们的研究结果强调了需要更好的院前中风识别方法。
