1 Neurology, Clinical Neurosciences, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
2 Molecular Neurology, Research Programs Unit, University of Helsinki, Helsinki, Finland.
Int J Stroke. 2019 Jun;14(4):409-416. doi: 10.1177/1747493019830315. Epub 2019 Feb 13.
Accurate identification of acute stroke by Emergency Medical Dispatchers (EMD) is essential for timely and purposeful deployment of Emergency Medical Services (EMS), and a prerequisite for operating mobile stroke units. However, precision of EMD stroke recognition is currently modest.
We sought to identify targets for improving dispatcher stroke identification.
Dispatch codes and EMS patient records were cross-linked to investigate factors associated with an incorrect dispatch code in a prospective observational cohort of 625 patients with a final diagnosis of acute stroke or transient ischemic attack (TIA), transported to our stroke center as candidates for recanalization therapies. Call recordings were analyzed in a subgroup that received an incorrect low-priority dispatch code indicating a fall or unknown acute illness ( = 46).
Out of 625 acute stroke/TIA patients, 450 received a high-priority stroke dispatch code (sensitivity 72.0%; 95% CI, 68.5-75.5). Independent predictors of dispatcher missed acute stroke included a bystander caller (aOR, 3.72; 1.48-9.34), confusion (aOR, 2.62; 1.59-4.31), fall at onset (aOR, 1.86; 1.24-2.78), and older age (aOR [per year], 1.02; 1.01-1.04). Of the analyzed call recordings, 71.7% revealed targets for improvement, including failure to recognize a Face Arm Speech Time (FAST) test symptom (21/46 cases, 18 with speech disturbance), or failure to thoroughly evaluate symptoms (12/46 cases).
Based on our findings, efforts to improve dispatcher stroke identification should primarily focus on improving recognition of acute speech disturbance, and implementing screening of FAST-symptoms in emergency phone calls revealing a fall or confusion.
URL: http://www.clinicaltrials.gov . Unique identifier: NCT02145663.
急诊医疗调度员（EMD）准确识别急性脑卒中对于及时、有针对性地调配急诊医疗服务（EMS）至关重要，也是运行移动卒中单元的前提条件。然而，目前 EMD 对卒中的识别精度并不高。
我们旨在确定可提高调度员卒中识别能力的目标。
通过前瞻性观察性队列研究，将调度代码与 EMS 患者记录进行交叉链接，以调查 625 例最终诊断为急性卒中和短暂性脑缺血发作（TIA）的患者的相关因素，这些患者被送往我们的卒中中心，作为接受再通治疗的候选者。在接受错误的低优先级调度代码（表示跌倒或不明急性疾病）的亚组中分析了呼叫记录（ = 46）。
在 625 例急性卒中和 TIA 患者中，450 例患者接收到了高优先级的卒中调度代码（敏感性为 72.0%；95%CI，68.5-75.5）。调度员漏诊急性卒中的独立预测因素包括旁观者呼叫者（OR，3.72；1.48-9.34）、意识模糊（OR，2.62；1.59-4.31）、起病时跌倒（OR，1.86；1.24-2.78）和年龄较大（OR[每年]，1.02；1.01-1.04）。在分析的呼叫记录中，71.7%存在需要改进的地方，包括未能识别 FAST 测试症状（46 例中有 21 例有言语障碍），或未能全面评估症状（46 例中有 12 例）。
基于我们的发现，提高调度员卒中识别能力的努力应主要集中在提高对急性言语障碍的识别能力上，并在出现跌倒或意识模糊的紧急电话中实施 FAST 症状筛查。
网址：http://www.clinicaltrials.gov 。独特标识符：NCT02145663。
