医护人员配备的急诊医疗团队的诊断准确性：一项回顾性观察队列研究，比较了 10 年间院前与医院诊断。
Diagnostic accuracy of physician-staffed emergency medical teams: a retrospective observational cohort study of prehospital versus hospital diagnosis in a 10-year interval.
机构信息
Department of Anesthesiology and Critical Care Medicine, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127, Bonn, Germany.
Department of Emergency Medicine, Bonn, University Hospital Bonn, Bonn, Germany.
出版信息
Scand J Trauma Resusc Emerg Med. 2019 Apr 2;27(1):36. doi: 10.1186/s13049-019-0617-3.
BACKGROUND
In Germany, emergency medical teams are staffed with physicians but evidence regarding their prehospital diagnostic accuracy remains poor.
OBJECTIVE
To evaluate the out-of-hospital diagnostic accuracy of physician-staffed emergency medical teams (PEMTs).
METHODS
A retrospective observational cohort study involving the Emergency Medical Service Bonn, Germany, from January to December 2004 and 2014 respectively. A total of 8346 patients underwent medical treatment by PEMTs, of which 1960 adult patients (inclusion criteria: ≥18 years of age, hospital diagnosis available) were included for further analysis. Reasons for non-inclusion: death on scene, outpatient, interhospital transfer, mental illness, false alarm, no hospital medical history available. The overall diagnostic accuracy (correct or false) of PEMTs was measured after matching the prehospital diagnosis with the corresponding diagnosis of the hospital. Secondary outcome measures were incidence of common PEMT diagnoses (acute coronary syndrome (ACS), dyspnea, stroke/intracerebral bleeding), recognition rate of a given disease by PEMTs, and prehospital diagnostic accuracy in elderly patients.
RESULTS
PEMT calls increased 2-fold over a decade (2004: n = 3151 vs. 2014: n = 5195). Overall diagnostic accuracy of PEMTs increased from 87.5% in 2004 to 92.6% in the year 2014. The incidence of common PEMT diagnoses such as ACS, dyspnea or stroke/intracerebral bleeding increased 2-fold from 2004 to 2014. The recognition rate of a given disease by the PEMT varied between 2004 and 2014: an increase was observed when a stroke/intracerebral bleeding was diagnosed (2004: 67% vs. 2014: 83%; p = 0.054), a decreased rate of recognition occurred when a syncope/collapse was diagnosed (2004: 81% vs. 2014: 56%; p = 0.007) and a sepsis appears to be a rare event for EMS personnel (2004: 0% vs. 2014: 23%). Linear regression analysis revealed that the prehospital diagnostic accuracy decreases in the elderly patient.
CONCLUSIONS
The overall prehospital diagnostic accuracy of PEMTs improved between the year 2004 and 2014 respectively. Our findings suggest that the incidence of common diseases (ACS, dyspnea stroke/intracerebral bleeding, sepsis) increased over a 10-year period. Diagnostic accuracy of different diseases varied but generally decreased in the elderly patient. Regular training of EMS personnel and public campaigns should be implemented to improve the diagnostic accuracy in the future.
背景
在德国，紧急医疗团队配备有医生，但有关其院前诊断准确性的证据仍然很差。
目的
评估由医生配备的紧急医疗团队（PEMT）的院外诊断准确性。
方法
这是一项回顾性观察队列研究，涉及德国波恩急救医疗服务，分别于 2004 年 1 月至 12 月和 2014 年 1 月至 12 月进行。共有 8346 名患者接受了 PEMT 的治疗，其中 1960 名成年患者（纳入标准：≥18 岁，有医院诊断）被纳入进一步分析。不纳入的原因：现场死亡、门诊、院内转院、精神疾病、误报、无医院病史。在对院前诊断与医院相应诊断进行匹配后，测量 PEMT 的总体诊断准确性（正确或错误）。次要结局指标为常见 PEMT 诊断（急性冠状动脉综合征（ACS）、呼吸困难、中风/脑出血）的发生率、PEMT 对特定疾病的识别率以及老年患者的院前诊断准确性。
结果
在十年间，PEMT 呼叫量增加了两倍（2004 年：n=3151 次；2014 年：n=5195 次）。PEMT 的总体诊断准确性从 2004 年的 87.5%增加到 2014 年的 92.6%。2004 年至 2014 年期间，ACS、呼吸困难或中风/脑出血等常见 PEMT 诊断的发生率增加了两倍。2004 年和 2014 年之间，PEMT 对特定疾病的识别率有所不同：中风/脑出血的诊断率有所提高（2004 年：67%；2014 年：83%；p=0.054），晕厥/晕厥的诊断率下降（2004 年：81%；2014 年：56%；p=0.007），而脓毒症似乎是 EMS 人员的罕见事件（2004 年：0%；2014 年：23%）。线性回归分析显示，院前诊断准确性在老年患者中下降。
结论
2004 年至 2014 年期间，PEMT 的总体院前诊断准确性有所提高。我们的研究结果表明，在过去十年中，常见疾病（ACS、呼吸困难、中风/脑出血、败血症）的发病率有所增加。不同疾病的诊断准确性有所不同，但一般在老年患者中下降。应实施对 EMS 人员的定期培训和公众宣传活动，以提高未来的诊断准确性。
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