在疑似大血管闭塞患者的急救电话中描述的皮层症状：157 次急救电话的描述性分析。
Cortical symptoms described in emergency calls for patients with suspected large vessel occlusion: a descriptive analysis of 157 emergency calls.
机构信息
Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
Department of Emergency, Emergency Medical Services, Centre for Prehospital Emergency Care, Anaesthesia and Pain Medicine, Tampere University Hospital, PO Box 2000, FI-33521, Tampere, Finland.
出版信息
BMC Emerg Med. 2022 Aug 13;22(1):146. doi: 10.1186/s12873-022-00706-5.
BACKGROUND
Emergency medical dispatchers typically use the dispatch code for suspected stroke when the caller brings up one or more symptoms from the face-arm-speech triad. Paramedics and emergency department physicians are trained to suspect large vessel occlusion stroke when the stroke patient presents with hemiparesis and cortical symptoms: neglect, aphasia, and conjugate eye deviation (CED). We hypothesized that these symptoms could be evident in the emergency call. In this study, we aimed to describe common symptoms mentioned in the emergency calls for paramedic-suspected thrombectomy candidates. Secondly, we wanted to explore how the question about CED arises in the Finnish suspected stroke dispatch protocol. Our third aim was to find out if the symptoms brought up in suspected stroke and non-stroke dispatches differed from each other.
METHODS
This was a retrospective study with a descriptive analysis of emergency calls for patients with paramedic-suspected large vessel occlusion stroke. We listened to the emergency calls for 157 patients transported to Tampere University Hospital, a Finnish comprehensive stroke centre. Two researchers listened for symptoms brought up in these calls and filled out a pre-planned case report form.
RESULTS
Speech disturbance was the most common symptom brought up in 125 (80%) calls. This was typically described as an inability to speak any words (n = 65, 52% of calls with speech disturbance). Other common symptoms were falling down (n = 63, 40%) and facial asymmetry (n = 41, 26%). Suspicion of stroke was mentioned by 44 (28%) callers. When the caller mentioned unconsciousness the emergency dispatcher tended to use a non-stroke dispatch code. The dispatchers adhered poorly to the protocol and asked about CED in only 57% of suspected stroke dispatches. We found CED in 12 emergency calls and ten of these patients were diagnosed with large vessel occlusion.
CONCLUSION
In cases where paramedics suspected large vessel occlusion stroke, typical stroke symptoms were described during the emergency call. Speech disturbance was typically described as inability to say anything. It is possible to further develop suspected stroke dispatch protocols to recognize thrombectomy candidates from ischemic cortical signs such as global aphasia and CED.
背景
当来电者出现面部-手臂-言语三联征的一个或多个症状时，急救医疗调度员通常会使用疑似中风的调度代码。护理人员和急诊医生在中风患者出现偏瘫和皮质症状时，即忽略、失语和共轭眼偏斜（CED）时，被训练怀疑大血管闭塞性中风。我们假设这些症状在紧急呼叫中是明显的。在这项研究中，我们旨在描述在护理人员怀疑取栓候选者的紧急呼叫中提到的常见症状。其次，我们想探讨芬兰疑似中风调度协议中 CED 问题是如何出现的。我们的第三个目标是确定疑似中风和非中风调度中提出的症状是否彼此不同。
方法
这是一项回顾性研究，对护理人员怀疑大血管闭塞性中风的患者的紧急呼叫进行描述性分析。我们听取了 157 名送往芬兰综合卒中中心坦佩雷大学医院的患者的紧急呼叫。两名研究人员听取了这些呼叫中提出的症状，并填写了预先计划的病例报告表。
结果
言语障碍是 125 个（80%）呼叫中最常见的症状。这通常被描述为无法说出任何单词（n=65，占言语障碍呼叫的 52%）。其他常见症状是摔倒（n=63，占 40%）和面部不对称（n=41，占 26%）。有 44 名（28%）来电者怀疑中风。当来电者提到意识丧失时，紧急调度员倾向于使用非中风调度代码。调度员未能严格遵守协议，仅在 57%的疑似中风调度中询问 CED。我们在 12 个紧急呼叫中发现了 CED，其中 10 名患者被诊断为大血管闭塞。
结论
在护理人员怀疑大血管闭塞性中风的情况下，典型的中风症状在紧急呼叫中描述。言语障碍通常被描述为无法说出任何话。可以进一步开发疑似中风调度协议，以从缺血性皮质体征（如完全性失语和 CED）中识别取栓候选者。
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