Supples Michael, Jelden Katelyn, Pallansch Jenna, Russell Frances M
Emergency Medicine, Indiana University School of Medicine, Indianapolis, USA.
Cureus. 2022 Jun 12;14(6):e25866. doi: 10.7759/cureus.25866. eCollection 2022 Jun.
Introduction Early diagnosis and optimization of heart failure therapies in patients with acute heart failure (AHF), including in the prehospital setting, is crucial to improving outcomes. However, making the diagnosis of AHF in the prehospital setting is difficult. The goal of this study was to evaluate the accuracy of prehospital diagnosis (AHF versus not heart failure [HF]) in patients with acute dyspnea when compared to final hospital diagnosis. Methods We conducted a retrospective study of adult patients transported by emergency medical services (EMS) with a primary or secondary complaint of shortness of breath. Patients were identified through an EMS electronic database (ESO) and matched to their hospital encounter. ESO was reviewed for prehospital diagnosis and management. Hospital electronic medical records were reviewed to determine final hospital diagnosis, management in the emergency department and hospital, disposition, and length of stay. The primary outcome compared prehospital diagnosis to final hospital diagnosis, which served as our criterion standard. Results Of 199 included patients, 50 (25%) had a final diagnosis of AHF. Prehospital paramedic sensitivity and accuracy for AHF were 14% (7/50; confidence interval [CI] 0.06-0.26) and 77% (CI 0.70-0.82), respectively. In the 50 patients with AHF, 14 (28%) received nitroglycerin in the prehospital setting, while 27 (54.0%) patients were inappropriately treated with albuterol. Conclusion Prehospital paramedics had poor sensitivity and moderate accuracy for the diagnosis of AHF. A small percentage of patients ultimately diagnosed with AHF had HF therapy initiated in the prehospital setting. This data highlights the fact that AHF is difficult to diagnose in the prehospital setting and is commonly missed.
引言 对急性心力衰竭（AHF）患者，包括在院前环境中进行早期诊断和优化心力衰竭治疗，对于改善预后至关重要。然而，在院前环境中诊断AHF很困难。本研究的目的是评估与最终医院诊断相比，急性呼吸困难患者院前诊断（AHF与非心力衰竭[HF]）的准确性。方法 我们对由紧急医疗服务（EMS）转运的、以呼吸急促为主诉或次要主诉的成年患者进行了一项回顾性研究。通过EMS电子数据库（ESO）识别患者，并将其与医院就诊情况进行匹配。对ESO进行回顾以获取院前诊断和治疗情况。审查医院电子病历以确定最终医院诊断、急诊科和医院的治疗、处置及住院时间。主要结局是将院前诊断与最终医院诊断进行比较，最终医院诊断作为我们的标准参照。结果 在纳入的199例患者中，50例（25%）最终诊断为AHF。院前护理人员对AHF的敏感性和准确性分别为14%（7/50；置信区间[CI]为0.06 - 0.26）和77%（CI为0.70 - 0.82）。在50例AHF患者中，14例（28%）在院前接受了硝酸甘油治疗，而27例（54.0%）患者接受了不适当的沙丁胺醇治疗。结论 院前护理人员对AHF的诊断敏感性较差，准确性中等。最终诊断为AHF的患者中，有一小部分在院前开始了HF治疗。这些数据凸显了AHF在院前环境中难以诊断且常被漏诊的事实。
