Oostema J Adam, Chassee Todd, Reeves Mathew
Prehosp Emerg Care. 2018 Jul-Aug;22(4):466-471. doi: 10.1080/10903127.2017.1405131. Epub 2018 Jan 16.
As the first point of contact for patients activating emergency medical services (EMS), emergency dispatchers have the earliest opportunity to recognize stroke. We sought to quantify dispatcher stroke recognition and its relationships with EMS stroke recognition and response speed.
We assembled a cohort of consecutive EMS-transported patients with a dispatcher suspected stroke or a hospital discharge diagnosis of stroke or transient ischemic attack (TIA). Dispatcher sensitivity and positive predictive value (PPV) for stroke recognition were calculated. Multivariable logistic regression analysis was used to determine predictors of dispatcher recognition and relationships between dispatcher recognition and downstream care.
During a 12-month period, 601 patients met inclusion criteria. Dispatchers suspected stroke in 229/324 (sensitivity = 70.7% [65.5 to 75.4%]) confirmed stroke/TIA cases and correctly assigned a suspected stroke label in 229/506 cases (PPV = 45.3% [41.0 to 49.6%]). Dispatchers had higher odds of recognizing ischemic strokes (aOR 3.4 [1.4 to 8.5]) and lower odds of recognizing patients with visual deficits (aOR = 0.4 [0.2 to 0.9]) or vomiting (aOR = 0.3 [0.1 to 0.9]). Dispatcher suspected stroke cases received more on-scene stroke screens (79.0% vs. 54.7%, p < 0.0001) and were more often recognized by EMS as strokes (77.7% vs. 57.9%, p = 0.0005). Dispatcher recognition was independently associated with EMS stroke recognition (aOR = 3.8 [1.9 to 7.7]), but not with transportation times, door-to-CT times, or t-PA delivery.
Emergency dispatcher stroke recognition is associated with higher rates of on-scene stroke scale performance and EMS ischemic stroke recognition but not with reduced transport times, door-to-CT times, or t-PA treatment.
作为启动紧急医疗服务（EMS）的患者的第一接触点，急救调度员有最早的机会识别中风。我们试图量化调度员对中风的识别情况及其与EMS对中风的识别和反应速度之间的关系。
我们收集了一组连续的由EMS转运的患者，这些患者要么被调度员怀疑为中风，要么出院诊断为中风或短暂性脑缺血发作（TIA）。计算调度员对中风识别的敏感性和阳性预测值（PPV）。采用多变量逻辑回归分析来确定调度员识别的预测因素以及调度员识别与下游护理之间的关系。
在12个月期间，601名患者符合纳入标准。在229/324例（敏感性=70.7%[65.5%至75.4%]）确诊的中风/TIA病例中，调度员怀疑为中风，在229/506例病例中正确分配了疑似中风标签（PPV=45.3%[41.0%至49.6%]）。调度员识别缺血性中风的几率更高（调整后比值比[aOR]3.4[1.4至8.5]），而识别有视觉缺陷（aOR=0.4[0.2至0.9]）或呕吐（aOR=0.3[0.1至0.9]）患者的几率更低。调度员怀疑为中风的病例接受现场中风筛查的比例更高（79.0%对54.7%，p<0.0001），并且被EMS识别为中风的频率更高（77.7%对57.9%，p=0.0005）。调度员的识别与EMS对中风的识别独立相关（aOR=3.8[1.9至7.7]），但与运输时间、门到CT时间或t-PA给药无关。
急救调度员对中风的识别与现场中风量表执行率较高以及EMS对缺血性中风的识别相关，但与运输时间缩短、门到CT时间缩短或t-PA治疗无关。
