Hedges J R, Mann N C, Meischke H, Robbins M, Goldberg R, Zapka J
Department of Emergency Medicine, Oregon Health Sciences University, Portland, USA.
Acad Emerg Med. 1998 Aug;5(8):773-80. doi: 10.1111/j.1553-2712.1998.tb02503.x.
To determine the consistency of responses to a standardized 2-part "key" question (Key-Q) about acute symptom onset in patients presenting with chest pain when measured using alternative questions (Qs) about symptom perception and decisions to seek treatment.
A structured patient interview was performed at 3 university teaching hospitals and 1 community hospital. Convenience samples of adult patients presenting to these EDs with chest pain were asked specific questions related to their symptoms and recognition of illness. Information obtained included the 2-part Key-Q: "What are the symptoms that brought you here today?" and "When did those symptoms start?" The alternative Qs (in order of use) were as follows: Q1 = "When did your very first symptom or sensation begin?"; Q2 = "When did your symptoms lead you to think something was wrong or that you were ill?"; Q3 = "When did your symptoms become serious enough for you to seek medical care?"; and Q4 = "When did you actually call 9-1-1/emergency medical services (EMS) or go to the hospital?" The documented ED arrival time, demographic variables, and whether the patient arrived by ambulance were obtained from the medical record. Patients also were queried regarding potential barriers to seeking medical care and their cardiac risk factors.
Of the 135 patients surveyed, 9 were unsure of the date and time of symptom onset. For the 126 patients with analyzable data, the mean (+/- SD) patient age was 62 +/- 16 years, and 59% were male. The general sequence of events reported from acute symptom onset until hospital care was Q1/Key-Q-->Q2-->Q3-->Q4-->ED arrival. The median differences and interquartile ranges (IQRs) in minutes between Q times and the Key-Q response were: Q1 = 0 (0-0); Q2 = 30 (0-210); Q3 = 140 (30-720); Q4 = 265 (90-1,215); and ED arrival = 340 (120-1,230). The interval from the Key-Q response until calling 9-1-1/EMS or going to the hospital was shorter for those who used an ambulance and for those who did not consult a physician first. The interval from the Key-Q response until considering symptoms to be serious was shorter for those with a family history of heart disease, but longer for non-white patients.
The Key-Q elicited a response recalled near the time of first symptoms and generally before the patient had concluded something was "wrong or that he or she was ill." Measurement of the out-of-hospital delay in chest pain patients using the Key-Q appears promising.
确定在使用关于症状感知和寻求治疗决策的替代问题（问题）来测量时，胸痛患者对一个标准化的两部分“关键”问题（关键问题）关于急性症状发作的回答的一致性。
在3所大学教学医院和1所社区医院进行了结构化的患者访谈。对到这些急诊科就诊的胸痛成年患者的便利样本询问了与他们的症状和疾病认知相关的具体问题。获得的信息包括两部分的关键问题：“今天导致你来这里的症状是什么？”以及“那些症状什么时候开始的？”替代问题（按使用顺序）如下：问题1 = “你的第一个症状或感觉什么时候开始的？”；问题2 = “你的症状什么时候让你觉得有问题或你生病了？”；问题3 = “你的症状什么时候严重到足以让你寻求医疗护理？”；问题4 = “你实际拨打911/紧急医疗服务（EMS）或去医院是什么时候？”从病历中获取记录的急诊科到达时间、人口统计学变量以及患者是否乘坐救护车到达。还询问了患者寻求医疗护理的潜在障碍及其心脏危险因素。
在接受调查的135名患者中，9名不确定症状发作的日期和时间。对于126名有可分析数据的患者，患者的平均（±标准差）年龄为62±16岁，59%为男性。从急性症状发作到医院护理报告的一般事件顺序是问题1/关键问题→问题2→问题3→问题4→急诊科到达。问题时间与关键问题回答之间的分钟中位数差异和四分位间距（IQR）为：问题1 = 0（0 - 0）；问题2 = 30（0 - 210）；问题3 = 140（30 - 720）；问题4 = 265（90 - 1215）；急诊科到达 = 340（120 - 1230）。对于乘坐救护车的患者和那些没有先咨询医生的患者，从关键问题回答到拨打911/EMS或去医院的间隔更短。对于有心脏病家族史的患者，从关键问题回答到认为症状严重的间隔更短，但对于非白人患者则更长。
关键问题引出的回答是在首次症状出现时附近回忆起来的，并且通常在患者得出有“问题或他/她生病了”的结论之前。使用关键问题测量胸痛患者的院外延迟似乎很有前景。
