急救人员初步诊断的准确性 - 一项横断面比较研究。
The accuracy of preliminary diagnoses made by paramedics - a cross-sectional comparative study.
机构信息
Department of Nursing Science, University of Turku, Department of Nursing Science 20014 University of Turku, Turku Finland and Satakunta Central Hospital, Sairaalantie 3, 28500, Pori, Finland.
Department of Perioperative Services, Intensive Care Medicine and Pain Management, University of Turku and Turku University Hospital, PO Box 52, 20521, Turku, Finland.
出版信息
Scand J Trauma Resusc Emerg Med. 2020 Jul 23;28(1):70. doi: 10.1186/s13049-020-00761-6.
BACKGROUND
Clinical decision-making skills of paramedics have been emphasized because of the growing complexity of emergency medicine nursing. A preliminary diagnosis made by a paramedic has an essential role in directing the subsequent care. An accurate preliminary diagnosis improves the patient's outcome. The research in this area is relatively scarce and there are no previous studies in Finland describing the accuracy of preliminary diagnoses made by paramedics. The aim of this study was to evaluate whether paramedics are making accurate preliminary diagnoses for the patients they are transporting to hospital. In addition, the aim was to describe the variables related to an accurate preliminary diagnosis.
METHODS
A cross-sectional comparative approach was used and conducted through a questionnaire to gather data from the paramedics. A total of 71 paramedics participated in the study and 378 patient cases were included. The paramedics were asked to describe the basic information of a case, to state their preliminary diagnosis, and give their own educational background. The accuracy of the paramedic's preliminary diagnosis was compared with the discharge diagnosis of the ED physicians retrieved from hospital's patient records. Logistic regression analysis and a binomial test were used to test the statistical significance.
RESULTS
The agreement between the paramedics' preliminary diagnosis vs. hospital diagnosis was 70% (n = 261). Diagnostic accuracy varied according to the medical condition from mental diseases and intoxication (86%, p = 0,000), cerebral strokes (81%, p = 0,007) to infections (31% p = 0,029). The educational background of a bachelor-degree-level paramedic (p = 0,016, 95% Cl 1,7-139,6) and a good self-assessment value (p = 0,003, 95% Cl 1,2-2,7) were related to making a correct diagnosis.
CONCLUSIONS
Paramedics are able to determine preliminary diagnoses at satisfactory level. The relationship between educational background and diagnostic accuracy suggests that there is a definitive need for a specific pre-hospital nursing education.
背景
由于急诊护理的复杂性不断增加，急救护理人员的临床决策技能受到重视。急救人员做出的初步诊断对于指导后续护理至关重要。准确的初步诊断可改善患者的预后。该领域的研究相对较少，芬兰以前也没有研究描述急救人员做出的初步诊断的准确性。本研究旨在评估急救人员在将患者送往医院时是否做出准确的初步诊断。此外，本研究还旨在描述与准确初步诊断相关的变量。
方法
采用横断面比较方法，通过问卷收集急救人员的数据。共有 71 名急救人员参与了这项研究，共纳入 378 例患者。急救人员被要求描述病例的基本信息、初步诊断，并提供自己的教育背景。将急救人员的初步诊断与从医院病历中检索到的急诊科医生的出院诊断进行比较，以评估初步诊断的准确性。使用逻辑回归分析和二项式检验来检验统计显著性。
结果
急救人员的初步诊断与医院诊断的一致性为 70%（n=261）。诊断准确性因医疗状况而异，从精神疾病和中毒（86%，p=0.000）、中风（81%，p=0.007）到感染（31%，p=0.029）。具有学士学位水平的急救人员的教育背景（p=0.016，95%Cl 1.7-139.6）和良好的自我评估值（p=0.003，95%Cl 1.2-2.7）与正确诊断相关。
结论
急救人员能够做出令人满意的初步诊断。教育背景与诊断准确性之间的关系表明，需要明确的特定的院前护理教育。
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