Khoy University of Medical Sciences, Khoy, Iran.
Department of Nursing, Khoy University of Medical Sciences, Khoy, Iran.
Air Med J. 2022 Mar-Apr;41(2):228-232. doi: 10.1016/j.amj.2021.10.013. Epub 2021 Dec 6.
Making an accurate clinical diagnosis in the field of prehospital is of great challenge in medical services. This study aimed to determine agreement between prehospital and in-hospital diagnoses.
The diagnostic agreement was determined by a comparison of the discharge diagnosis with the prehospital emergency technicians in a period of 6 months at the emergency medical services in northwest Azerbaijan. The diagnostic agreement of discharge diagnoses was compared with the fist diagnosis by the paramedics. The results were analyzed using the kappa agreement coefficient and the chi-square test.
The overall agreement between the diagnosis made by the emergency medical technicians and the hospital's first diagnosis was 67% (95% confidence interval [CI], 61%-77%; k = 0.61; 95% CI, 0.56-0.67), whereas the agreement between the first diagnosis made by the emergency medical technicians and the hospital discharge diagnosis was 58% (95% CI, 49%-65%; k = 0.42; 95% CI, 0.37-0.48).There was a high proportion of diagnostic agreement for pregnancy (100%), poisoning by drugs (88%), essential (primary) hypertension (86%), and ischemic heart diseases (72%). There was a low proportion of diagnostic agreement for weakness (39%), mixed anxiety and depressive disorder (43%), and cerebellar stroke syndrome (59%).
Our attention in practice and emergency medical courses should be directed to diseases that have a subjective history, such as weakness and anxiety, due to the high proportion of incorrect diagnoses by the prehospital emergency technician. It should be noted that most of the incorrectly diagnosed cases were overestimated with another coronary syndrome.
在院前医疗服务领域做出准确的临床诊断具有很大的挑战性。本研究旨在确定院前和院内诊断之间的一致性。
在阿塞拜疆西北部的 6 个月期间，通过比较急诊医疗服务中出院诊断与院前急救技术员的诊断，确定诊断一致性。将出院诊断的诊断一致性与急救人员的初步诊断进行比较。使用 Kappa 一致性系数和卡方检验对结果进行分析。
急救技术员做出的诊断与医院首次诊断之间的总体一致性为 67%（95%置信区间[CI]，61%-77%；K=0.61；95%CI，0.56-0.67），而急救技术员做出的首次诊断与医院出院诊断之间的一致性为 58%（95%CI，49%-65%；K=0.42；95%CI，0.37-0.48）。妊娠（100%）、药物中毒（88%）、原发性高血压（86%）和缺血性心脏病（72%）的诊断一致性比例较高。乏力（39%）、混合焦虑和抑郁障碍（43%）和小脑中风综合征（59%）的诊断一致性比例较低。
在实践和急诊医疗课程中，我们应该将注意力集中在那些具有主观病史的疾病上，例如乏力和焦虑，因为院前急救技术员的错误诊断比例较高。需要注意的是，大多数错误诊断的病例都被高估为另一种冠状综合征。
