Balen Frederic, Saget François, Benhamed Axel, Boudjemline Oussama-Ibrahim, Girard Lisa, Lescanne Elisa, Mimouni Pauline, Reuter Paul-Georges, Charpentier Sandrine, Marjanovic Nicolas
Emergency Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France.
CERPOP- EQUITY, INSERM, Toulouse, France.
Scand J Trauma Resusc Emerg Med. 2025 May 16;33(1):88. doi: 10.1186/s13049-025-01405-3.
Acute dyspnea is a frequent cause to call the Emergency Medical Call Center (EMCC). The main challenge for EMCC dispatchers is to quickly identify patients that will require respiratory support in order to provide them with the most accurate prehospital response. Our main objective was to derivate a score assessable during the first call to detect the most severe patients needing medical assistance.
This prospective observational cohort study was conducted in four different French EMCC from January 22nd to March 7th 2024. Patients over the age of 18 years old that called once the EMCC for acute dyspnea were included in our study. The primary endpoint was an immediate respiratory support requirement (i.e. high-flow oxygen, non-invasive ventilation or mechanical ventilation after intubation) before or at the Emergency Department Registration. Variables of interest to predict respiratory support were prospectively collected in each EMCC. A multivariate analysis by stepwise logistic regression was used to select variables associated with the primary endpoint and to create in the TeLePhon Respiratory Score (TeLePoR score). The TeLePoR score was compared to medical dispatcher intuition for predicting respiratory support.
Six hundred and forty-nine patients were analyzed, including 49 (8%) that required immediate respiratory support. The risk factors included in the TeLePoR score were: altered ability to speak complete sentences (OR = 8.62; CI95% = [3.49-21.3]), abdominal respiration (OR = 2.42; CI95% = [1.23-4.76]), altered consciousness (OR = 2.05; CI95% = [0.90-4.65]) and self-report breathing discomfort > 7/10 (OR = 1.83; CI95% = [0.96-3.47]) respectively. Considering these factors, TeLePoR score presented a 0.810 AUC. Medical dispatcher intuition was not statistically superior to TelePoR score to predict immediate respiratory support (AUC = 0.836 vs. 0.810; p = 0.431).
TeLePoR score is a simple scoring system including 4 variables to predict immediate respiratory support in patients calling the EMCC for acute dyspnea.
急性呼吸困难是拨打紧急医疗呼叫中心（EMCC）的常见原因。EMCC调度员面临的主要挑战是快速识别需要呼吸支持的患者，以便为他们提供最准确的院前急救。我们的主要目标是得出一个在首次呼叫时即可评估的评分，以检测最需要医疗救助的重症患者。
这项前瞻性观察性队列研究于2024年1月22日至3月7日在法国四个不同的EMCC进行。年龄在18岁以上因急性呼吸困难拨打一次EMCC的患者被纳入我们的研究。主要终点是在急诊科登记之前或之时立即需要呼吸支持（即高流量氧气、无创通气或插管后机械通气）。在每个EMCC前瞻性收集预测呼吸支持的相关变量。采用逐步逻辑回归进行多变量分析，以选择与主要终点相关的变量，并创建电话呼吸评分（TeLePoR评分）。将TeLePoR评分与医疗调度员预测呼吸支持的直觉进行比较。
分析了649例患者，其中49例（8%）需要立即呼吸支持。TeLePoR评分纳入的危险因素包括：说出完整句子的能力改变（OR = 8.62；95%CI = [3.49 - 21.3]）、腹式呼吸（OR = 2.42；95%CI = [1.23 - 4.76]）、意识改变（OR = 2.05；95%CI = [0.90 - 4.65]）和自我报告呼吸不适>7/10（OR = 1.83；95%CI = [0.96 - 3.47]）。综合这些因素，TeLePoR评分的曲线下面积（AUC）为0.810。在预测立即呼吸支持方面，医疗调度员的直觉在统计学上并不优于TeLePoR评分（AUC = 0.836对0.810；p = 0.431）。
TeLePoR评分是一个简单的评分系统，包含4个变量，用于预测因急性呼吸困难拨打EMCC的患者是否需要立即呼吸支持。
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