Kothari R, Barsan W, Brott T, Broderick J, Ashbrock S
Department of Emergency Medicine, University of Cincinnati College of Medicine, OH 45267, USA.
Stroke. 1995 Jun;26(6):937-41. doi: 10.1161/01.str.26.6.937.
This pilot study evaluated the frequency and accuracy of diagnosis of stroke made by prehospital care system dispatchers, emergency medical technicians (EMTs), and paramedics in one emergency medical services (EMS) system. In addition, the study determined patient prehospital triage and time intervals in the transport and examination of patients given a diagnosis of stroke by this EMS system.
We reviewed records of 4413 consecutive prehospital records of a two-tiered EMS system for patients with potential stroke. Hospital records were obtained for patients given a diagnosis of stroke or transient ischemic attack (TIA) by an EMS dispatcher, EMT, or paramedic. The EMS system studied serves a community of 13,000 within the greater Cincinnati area.
Of 4413 EMS on-scene evaluations, the diagnosis of stroke or TIA was made by an EMT or paramedic for 96 patients (2%). Of the study population (n = 86), a final hospital discharge diagnosis of stroke or TIA was made for 62 patients (72%). EMS dispatchers correctly identified 52% and paramedics 72% of these 86 patients as having sustained a stroke or TIA. Twenty-two of the 86 patients required paramedic-level interventions, which included three intubations. Of the 24 patients whose symptoms were misdiagnosed as stroke or TIA by the paramedics, 16 (19%) had acute conditions for which effective therapies are available. Prehospital personnel arrived at the scene to examine potential stroke patients in a mean of 3 minutes after the emergency 911 call was received by the dispatcher. Patients transported by basic life support units (EMTs) arrived earlier at the hospital than did those transported by advanced life support units (paramedics) (40 +/- 1 versus 45 +/- 1 minutes, P = .004). However, patients transported by advanced life support units were seen by a physician sooner after arrival at the emergency department (10 +/- 2 versus 20 +/- 4 minutes, P = .02) and underwent computed tomography of the brain sooner (47 +/- 5 versus 69 +/- 10 minutes, P = .04).
Prehospital evaluation of potential stroke patients can be accomplished promptly after the EMS system is activated. Urgent evaluation and transport of potential stroke patients is justified because paramedic-level interventions are frequently required and because almost 20% of patients with potential stroke have acute medical conditions for which effective specific therapies are available.
本初步研究评估了一个紧急医疗服务（EMS）系统中，院前急救系统调度员、急救医疗技术员（EMT）和护理人员对中风诊断的频率和准确性。此外，该研究还确定了该EMS系统诊断为中风的患者的院前分诊情况以及转运和检查过程中的时间间隔。
我们回顾了一个两级EMS系统中4413例连续的潜在中风患者的院前记录。获取了被EMS调度员、EMT或护理人员诊断为中风或短暂性脑缺血发作（TIA）的患者的医院记录。所研究的EMS系统服务于大辛辛那提地区一个13000人的社区。
在4413次EMS现场评估中，EMT或护理人员对96例患者（2%）做出了中风或TIA的诊断。在研究人群（n = 86）中，最终医院出院诊断为中风或TIA的有62例患者（72%）。在这86例患者中，EMS调度员正确识别出52%，护理人员正确识别出72%为中风或TIA患者。86例患者中有22例需要护理人员级别的干预，其中包括3例插管。在护理人员误诊为中风或TIA的24例患者中，16例（19%）患有可进行有效治疗的急性疾病。院前急救人员在调度员接到911紧急呼叫后平均3分钟到达现场对潜在中风患者进行检查。由基础生命支持单位（EMT）转运的患者比由高级生命支持单位（护理人员）转运的患者更早到达医院（40±1分钟对45±1分钟，P = 0.004）。然而，由高级生命支持单位转运的患者在到达急诊科后更快见到医生（10±2分钟对20±4分钟，P = 0.02），并且更快接受脑部计算机断层扫描（47±5分钟对69±10分钟，P = 0.04）。
EMS系统启动后可迅速完成对潜在中风患者的院前评估。对潜在中风患者进行紧急评估和转运是合理的，因为经常需要护理人员级别的干预，而且几乎20%的潜在中风患者患有可进行有效特效治疗的急性疾病。
