Prevalence and predictors of hospital prealerting in acute stroke: a mixed methods study.
Prevalence and predictors of hospital prealerting in acute stroke: a mixed methods study.
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DOI：
10.1136/emermed-2014-204392
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发表时间：
2016-07
期刊：
影响因子：
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通讯作者：
CLAHRC BBC investigators
中科院分区：
文献类型：
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作者：
Sheppard JP;Lindenmeyer A;Mellor RM;Greenfield S;Mant J;Quinn T;Rosser A;Sandler D;Sims D;Ward M;McManus RJ;CLAHRC BBC investigators
溶栓治疗可以显著降低卒中的负担，但安全有效的治疗时间窗较短。在经由救护车前往医院的患者中，发送“预警”消息可以显著提高治疗的及时性。检查医院预警的流行程度，预警协议的遵守程度以及影响紧急医疗服务（EMS）工作人员发送预警的决定的因素。使用来自医院和EMS记录的关联数据，对西米德兰兹（英国）医院两个急性中风病房收治的患者进行队列研究。逻辑回归模型检查预警资格和是否发送预警消息之间的关联。在半结构化访谈中，EMS工作人员被问及他们对疑似中风患者的经历。在符合本研究条件的539例患者中，招募了271例（51%）。其中，只有79家（29%）符合当地协议规定的预警标准，但有143家（53%）被预警。面部、手臂、语言测试症状数量增加（1个症状，OR 6.14，95% CI 2.06至18.30，p=0.001; 2个症状，OR 31.36，95% CI 9.91至99.24，p<0.001; 3种症状，OR 75.84，95%CI 24.68至233.03，p<0.001）和症状发作5小时内EMS接触 （OR 2.99，95% CI 1.37至6.50 p=0.006）是预警的关键预测因素，但整体预警资格不是（OR 1.92，95% CI 0.85至4.34 p=0.12）。在定性访谈中，EMS工作人员表现出不同的理解预警协议，并描述了挫折时，他们的解释预警标准不共享的艾德的工作人员。在这项研究中，多达一半的疑似卒中患者被EMS工作人员预先警告，无论是否合格，导致在交接过程中与艾德工作人员发生分歧。统一EMS和艾德工作人员的期望，也许通过简化预警协议，可以考虑促进更适当地使用医院预警急性卒中。
Thrombolysis can significantly reduce the burden of stroke but the time window for safe and effective treatment is short. In patients travelling to hospital via ambulance, the sending of a ‘prealert’ message can significantly improve the timeliness of treatment. Examine the prevalence of hospital prealerting, the extent to which prealert protocols are followed and what factors influence emergency medical services (EMS) staff's decision to send a prealert. Cohort study of patients admitted to two acute stroke units in West Midlands (UK) hospitals using linked data from hospital and EMS records. A logistic regression model examined the association between prealert eligibility and whether a prealert message was sent. In semistructured interviews, EMS staff were asked about their experiences of patients with suspected stroke. Of the 539 patients eligible for this study, 271 (51%) were recruited. Of these, only 79 (29%) were eligible for prealerting according to criteria set out in local protocols but 143 (53%) were prealerted. Increasing number of Face, Arm, Speech Test symptoms (1 symptom, OR 6.14, 95% CI 2.06 to 18.30, p=0.001; 2 symptoms, OR 31.36, 95% CI 9.91 to 99.24, p<0.001; 3 symptoms, OR 75.84, 95% CI 24.68 to 233.03, p<0.001) and EMS contact within 5 h of symptom onset (OR 2.99, 95% CI 1.37 to 6.50 p=0.006) were key predictors of prealerting but eligibility for prealert as a whole was not (OR 1.92, 95% CI 0.85 to 4.34 p=0.12). In qualitative interviews, EMS staff displayed varying understanding of prealert protocols and described frustration when their interpretation of the prealert criteria was not shared by ED staff. Up to half of the patients presenting with suspected stroke in this study were prealerted by EMS staff, regardless of eligibility, resulting in disagreements with ED staff during handover. Aligning the expectations of EMS and ED staff, perhaps through simplified prealert protocols, could be considered to facilitate more appropriate use of hospital prealerting in acute stroke.