Accuracy of paramedic identification of stroke and transient ischemic attack in the field.
Accuracy of paramedic identification of stroke and transient ischemic attack in the field.
复制标题
DOI：
10.1080/10903129808958866
复制
发表时间：
1998-07-01
期刊：
影响因子：
--
通讯作者：
Corry, M D
中科院分区：
文献类型：
--
作者：
Smith, W S;Isaacs, M;Corry, M D
目的：确定城市紧急医疗服务系统中护理人员对急性脑卒中识别的准确性。方法：回顾性分析六个月期间由护理人员送往两所大学医院的所有患者。受试者通过卒中/短暂性脑缺血发作（TIA）的护理人员编码或急性卒中和TIA的最终出院ICD-9诊断来识别。计算卒中护理人员识别的敏感性和阳性预测值，并确定患者院前和住院过程中从症状发作到各点的时间间隔。结果：共发现96例患者，其中81例符合急性脑卒中或TIA诊断。护理人员确定了81例患者中的49例（敏感性61%）。15名患者被护理人员确定为中风，但患者最终的诊断不同（阳性预测值77%）。患者或其家属在拨打911前平均等待2.5 +/- 3.6 （SD）小时，从症状出现到获得头部影像学检查平均等待5.1 +/- 4.0 （SD）小时。结论：旧金山县的护理人员在他们的文件中将患者列为中风/TIA时，有四分之三的时间是正确的。然而，他们没有确定39%的中风患者，这些患者可能从紧急治疗中受益。中风患者要过很长一段时间才能联系911。这突出了为有中风风险的社区制定教育计划的必要性，以及为医护人员制定更准确地识别急性中风患者的教育计划的必要性。
PURPOSE: To determine the accuracy of acute stroke identification by paramedics in an urban emergency medical services system.METHODS: Retrospective chart review of all patient encounters by paramedics resulting in transport to two university hospitals during a six-month period. Subjects were identified by paramedic coding of stroke/transient ischemic attach (TIA) or final hospital discharge ICD-9 diagnosis of acute stroke and TIA. The sensitivity and positive predictive value for paramedic identification of stroke were calculated, and the time intervals from symptom onset to various points along the patients' prehospital and hospital courses were identified.RESULTS: Ninety-six patients were identified, of whom 81 met the diagnosis of acute stroke or TIA. Paramedics identified 49 of these 81 patients (sensitivity 61%). Fifteen patients were identified by paramedics as having a stroke when the patient ultimately had a different diagnosis (positive predictive value 77%) Patients or their families waited on average 2.5 +/- 3.6 (SD) hours before accessing 911, and a mean of 5.1 +/- 4.0 (SD) hours elapsed from symptom onset until head imaging studies were obtained.CONCLUSION: Paramedics in San Francisco County were correct three-fourths of the time when their documentation listed patients as having stroke/TIA. However, they did not identify 39% of stroke victims, a patient population who may benefit from urgent therapy. A substantial period elapses before stroke victims access 911. This highlights the need to develop an educational program for the community at risk for stroke, and another for paramedics directed toward more accurate identification of acute stroke victims.