Raatiniemi L, Liisanantti J, Tommila M, Moilanen S, Ohtonen P, Martikainen M, Voipio V, Reitala J, Iirola T
Centre for Pre-Hospital Emergency Medicine, Oulu University Hospital, Oulu, Finland.
Medical Research Center, Research Group of Surgery, Anesthesiology and Intensive Care, Oulu University, Oulu, Finland.
Acta Anaesthesiol Scand. 2017 May;61(5):557-565. doi: 10.1111/aas.12881. Epub 2017 Mar 19.
The benefits of the Helicopter Emergency Medical Service (HEMS) and dispatch accuracy are continuously debated, and a widely accepted score to measure the benefits of the mission is lacking. The HEMS Benefit Score (HBS) has been used in Finnish helicopter emergency medical services, but studies are lacking. The National Advisory Committee for Aeronautics (NACA) score is widely used to measure the severity of illness or injury in the pre-hospital setting, but it has many critics due to its subjectivity. We investigated the inter-rater and rater-against-reference reliability of these scores.
Twenty-five fictional HEMS missions were created by an expert panel. A total of 22 pre-hospital physicians were recruited to participate in the study from two different HEMS bases. The participants received written instructions on the use of the scores. Intraclass correlation coefficients (ICCs) and mean differences between rater-against-reference values were calculated.
A total of 17 physicians participated in the study. The ICC was 0.70 (95% CI 0.57-0.83) for the HBS and 0.65 (95% CI 0.51-0.79) for the NACA score. Mean differences between references and raters were -0.09 (SD 0.72) for the HBS and 0.28 (SD 0.61) for the NACA score, indicating that raters scored some lower NACA values than reference values formed by an expert panel.
The HBS and NACA score had substantial inter-rater reliability. In addition, the rater-against-reference values were acceptable, though large differences were observed between individual raters and references in some clinical cases.
直升机紧急医疗服务（HEMS）的益处及调度准确性一直存在争议，且缺乏一个被广泛接受的衡量该任务益处的评分系统。HEMS益处评分（HBS）已在芬兰直升机紧急医疗服务中使用，但相关研究较少。国家航空咨询委员会（NACA）评分被广泛用于衡量院前环境中疾病或损伤的严重程度，但因其主观性受到诸多批评。我们调查了这些评分的评分者间信度以及评分者与参考标准之间的信度。
一个专家小组创建了25个虚构的HEMS任务。从两个不同的HEMS基地招募了总共22名院前医生参与研究。参与者收到了关于评分使用的书面说明。计算组内相关系数（ICC）以及评分者与参考标准值之间的平均差异。
共有17名医生参与了研究。HBS的ICC为0.70（95%可信区间0.57 - 0.83），NACA评分的ICC为0.65（95%可信区间0.51 - 0.79）。HBS的参考标准与评分者之间的平均差异为 -0.09（标准差0.72），NACA评分的平均差异为0.28（标准差0.61），这表明评分者对某些NACA值的评分低于专家小组形成的参考值。
HBS和NACA评分具有较高的评分者间信度。此外，评分者与参考标准值是可以接受的，尽管在某些临床案例中，个别评分者与参考标准之间存在较大差异。
