英格兰急救医疗服务接线员对院外心脏骤停识别的预测因素：一项混合方法诊断准确性研究。
Predictors of recognition of out of hospital cardiac arrest by emergency medical services call handlers in England: a mixed methods diagnostic accuracy study.
机构信息
School of Nursing, University of Central Lancashire, Brook Building, Preston, PR1 2HE, UK.
Newcastle University, Newcastle, UK.
出版信息
Scand J Trauma Resusc Emerg Med. 2021 Jan 6;29(1):7. doi: 10.1186/s13049-020-00823-9.
BACKGROUND
The aim of this study was to identify key indicator symptoms and patient factors associated with correct out of hospital cardiac arrest (OHCA) dispatch allocation. In previous studies, from 3% to 62% of OHCAs are not recognised by Emergency Medical Service call handlers, resulting in delayed arrival at scene.
METHODS
Retrospective, mixed methods study including all suspected or confirmed OHCA patients transferred to one acute hospital from its associated regional Emergency Medical Service in England from 1/7/2013 to 30/6/2014. Emergency Medical Service and hospital data, including voice recordings of EMS calls, were analysed to identify predictors of recognition of OHCA by call handlers. Logistic regression was used to explore the role of the most frequently occurring (key) indicator symptoms and characteristics in predicting a correct dispatch for patients with OHCA.
RESULTS
A total of 39,136 dispatches were made which resulted in transfer to the hospital within the study period, including 184 patients with OHCA. The use of the term 'Unconscious' plus one or more of symptoms 'Not breathing/Ineffective breathing/Noisy breathing' occurred in 79.8% of all OHCAs, but only 72.8% of OHCAs were correctly dispatched as such. 'Not breathing' was associated with recognition of OHCA by call handlers (Odds Ratio (OR) 3.76). The presence of key indicator symptoms 'Breathing' (OR 0.29), 'Reduced or fluctuating level of consciousness' (OR 0.24), abnormal pulse/heart rate (OR 0.26) and the characteristic 'Female patient' (OR 0.40) were associated with lack of recognition of OHCA by call handlers (p-values < 0.05).
CONCLUSIONS
There is a small proportion of calls in which cardiac arrest indicators are described but the call is not dispatched as such. Stricter adherence to dispatch protocols may improve call handlers' OHCA recognition. The existing dispatch protocol would not be improved by the addition of further terms as this would be at the expense of dispatch specificity.
背景
本研究旨在确定与正确的院外心脏骤停（OHCA）调度分配相关的关键指标症状和患者因素。在之前的研究中，3%至62%的 OHCA 未被紧急医疗服务呼叫处理人员识别，导致现场到达延迟。
方法
回顾性混合方法研究，纳入 2013 年 7 月 1 日至 2014 年 6 月 30 日期间从其所在地区的紧急医疗服务转移到英格兰一家急性医院的所有疑似或确诊 OHCA 患者。对紧急医疗服务和医院数据进行分析，包括紧急医疗服务电话的录音，以确定呼叫处理人员识别 OHCA 的预测因子。使用逻辑回归探索最常出现（关键）指标症状和特征在预测 OHCA 患者正确调度中的作用。
结果
共发出 39136 次调度，在此期间将患者转移至医院，其中 184 例为 OHCA。在所有 OHCA 中，术语“无意识”加上一个或多个症状“无呼吸/无效呼吸/嘈杂呼吸”的使用占 79.8%，但只有 72.8%的 OHCA 被正确调度为这种情况。“无呼吸”与呼叫处理人员识别 OHCA 有关（比值比（OR）3.76）。关键指标症状“呼吸”（OR 0.29）、“意识水平降低或波动”（OR 0.24）、异常脉搏/心率（OR 0.26）和特征“女性患者”（OR 0.40）的存在与呼叫处理人员无法识别 OHCA 有关（p 值<0.05）。
结论
有一小部分呼叫描述了心脏骤停指标，但未按此调度。更严格地遵守调度协议可能会提高呼叫处理人员对 OHCA 的识别能力。现有的调度协议不会通过添加其他术语来改进，因为这将以牺牲调度特异性为代价。
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