Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin (SS, DT, MN, LRB); Department of Institute of Health and Equity, Medical College of Wisconsin, Milwaukee, Wisconsin (AV, RF, MRC); Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin (MRC, LRB).
Prehosp Emerg Care. 2021 Sep-Oct;25(5):664-674. doi: 10.1080/10903127.2020.1817211. Epub 2020 Oct 7.
The prehospital care of asthma, bronchiolitis and croup is directed by evidence-based Emergency Medical Services (EMS) protocols. Determining the appropriate intervention for these conditions requires Emergency Medical Technicians-Paramedics (EMT-Ps) to correctly differentiate asthma/bronchospasm, bronchiolitis, and croup. The diagnostic accuracy of EMT-Ps for these pediatric respiratory distress conditions is unknown.
We hypothesized increasing provider age, years of provider experience, higher volume of pediatric cases, self-reported comfort with pediatric patients, and having children of one's own would be associated with increased accuracy in diagnosis on a validated multimedia questionnaire.
This is a cross-sectional study of paramedics from a single EMS agency who completed a validated, case-based questionnaire between July and September 2018. The multimedia questionnaire consisted of four cases, each of which included patient videos and lung sound recordings. Paramedics were asked to assess the severity of distress and ascribe the correct diagnosis and prehospital intervention for each case. Each paramedic completed the questionnaire independently. We defined high questionnaire performance as correctly identifying the diagnosis for ≥75% of cases and used multivariate regression to assess factors associated with high questionnaire performance. Provider age and EMS experience were reported in years and analyzed as continuous variables. Volume of pediatric cases was dichotomized to <1 and ≥1 case per shift and having children was dichotomized to either having children or not having children.
Of 514 paramedics, 420 (82%) completed the questionnaire. Overall, paramedics correctly assessed the severity of respiratory distress 92% of the time. However, they only ascribed the correct diagnosis 50% and selected the correct intervention(s) 38% of the time. Increasing age, years of experience, higher volume of pediatric cases, self-reported comfort with pediatric patients, and having children of their own were not associated with questionnaire performance.
Paramedics accurately assessed severity of distress in multimedia cases of asthma/bronchospasm, bronchiolitis and croup in children, but showed significant room for improvement in correctly identifying the diagnosis and in selecting appropriate intervention(s). Age, years of EMS experience, higher volume of clinical pediatric cases, self-reported comfort with pediatric patients, and having children of their own were not associated with questionnaire performance.
哮喘、细支气管炎和喉炎的院前急救由循证急救医疗服务 (EMS) 协议指导。确定这些病症的适当干预措施需要急救医疗技术员-护理人员 (EMT-P) 正确区分哮喘/支气管痉挛、细支气管炎和喉炎。 EMT-P 对这些儿科呼吸窘迫病症的诊断准确性尚不清楚。
我们假设，随着提供者年龄的增长、工作经验的增加、儿科病例量的增加、对儿科患者的自我报告舒适度以及自己的孩子，他们在验证多媒体问卷上的诊断准确性会提高。
这是一项对来自单一 EMS 机构的护理人员进行的横断面研究，他们在 2018 年 7 月至 9 月期间完成了一项经过验证的基于案例的问卷。多媒体问卷由四个案例组成，每个案例都包括患者视频和肺部声音记录。护理人员被要求评估病情的严重程度，并为每个病例正确诊断和院前干预。每个护理人员都独立完成了问卷。我们将高问卷表现定义为正确识别出 >75%的病例的诊断，并使用多元回归来评估与高问卷表现相关的因素。提供者年龄和 EMS 经验以年为单位报告，并作为连续变量进行分析。儿科病例量分为<1 次/班和≥1 次/班，有孩子的情况分为有孩子和没有孩子。
在 514 名护理人员中，有 420 名（82%）完成了问卷。总体而言，护理人员正确评估呼吸窘迫的严重程度 92%的时间。然而，他们只正确诊断出 50%的病例，正确选择干预措施 38%的时间。年龄的增加、工作经验的增加、儿科病例量的增加、对儿科患者的自我报告舒适度以及自己的孩子与问卷表现无关。
护理人员在儿童哮喘/支气管痉挛、细支气管炎和喉炎的多媒体病例中准确评估了病情严重程度，但在正确识别诊断和选择适当的干预措施方面仍有很大的改进空间。年龄、EMS 工作经验、儿科临床病例量、对儿科患者的自我报告舒适度以及自己的孩子与问卷表现无关。
