Identification of Generalized Convulsive Status Epilepticus from Emergency Medical Service Records: A Validation Study of Diagnostic Coding.
Identification of Generalized Convulsive Status Epilepticus from Emergency Medical Service Records: A Validation Study of Diagnostic Coding.
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DOI：
10.1080/10903127.2020.1817214
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发表时间：
2021-09
影响因子：
2.4
通讯作者：
Guterman EL
中科院分区：
文献类型：
--
作者：
Hart L;Sanford JK;Sporer KA;Kohn MA;Guterman EL
全身惊厥性癫痫持续状态 (GCSE) 是一种神经系统急症，需要院前识别和治疗。评估现实世界的实践需要准确识别目标人群；然而，尚不清楚紧急医疗服务 (EMS) 文档是否能准确识别 GCSE 患者。为了评估 GCSE 的 EMS 诊断印象的有效性，这是对 2013 年至 2018 年加州县 EMS 系统的电子病历的分析。我们确定了主要诊断印象为“癫痫发作”、“癫痫发作后”或“癫痫未另行指定 (NOS)”的所有病例，并且在每个诊断类别中，我们随机选择了 75 份成人记录和 25 份儿科记录。两位作者回顾了这 300 个图表的提供者叙述，以根据预先指定的定义确定临床癫痫诊断。我们计算了临床诊断的受试者间可靠性的 kappa。然后，我们计算了 EMS 诊断“癫痫发作”诊断的阳性预测值 (PPV)、敏感性和特异性，以识别 GCSE。根据癫痫发作病例在总体人群中的分布对敏感性和特异性计算进行加权。我们对 GCSE 或癫痫发作的 EMS 诊断不正确的记录进行了描述性分析。在 38,995 份癫痫发作总记录中，有 3401 例（8.7%）癫痫发作活跃病例、12,478 例（32.0%）癫痫发作-NOS 病例和 23,116 例（59.4%）癫痫发作后病例。 EMS 诊断为“癫痫发作”的 GCSE 的 PPV 为 65.0%（95% CI 54.8–74.3），敏感性为 54.6%（95% 置信区间 [CI] 39.3–69.0），特异性为 96.6%（95% CI 95.1–97.6）。将病例定义限制为接受 EMS 诊断为“癫痫发作”并接受苯二氮卓类药物治疗的患者会增加 PPV（80.2%；95% CI 69.9–88.2）和特异性（99.3%；95% CI 98.7–99.6），同时敏感性下降（25.1%；95% CI 17.0–35.3）。在审查的 300 份记录中，有 19 名 (6.3%) 患者的诊断与癫痫无关，包括非癫痫发作（7 条记录）、精神状态改变（8 条记录）、震颤（2 条记录）、焦虑（1 条记录）和中风（1 条记录）。 EMS 诊断印象具有合理的 PPV 和特异性，但 GCSE 的敏感性较低。改进的编码算法和训练将有助于改进基准测试、质量改进以及有关这种神经系统紧急情况的研究。
Generalized convulsive status epilepticus (GCSE) is a neurologic emergency demanding prehospital identification and treatment. Evaluating real-world practice requires accurately identifying the target population; however, it is unclear whether emergency medical services (EMS) documentation accurately identifies patients with GCSE. To evaluate the validity of EMS diagnostic impressions for GCSE This was an analysis of electronic medical records of a California county EMS system from 2013 to 2018. We identified all cases with a primary diagnostic impression of “seizure-active,” “seizure-post,” or “seizure-not otherwise specified (NOS)” and within each diagnostic category, we randomly selected 75 adult and 25 pediatric records. Two authors reviewed the provider narrative of these 300 charts to determine a clinical seizure diagnosis according to prespecified definitions. We calculated a kappa for interrater reliability of the clinical diagnosis. We then calculated the positive predictive value (PPV), sensitivity, and specificity of an EMS diagnosis of “seizure-active” diagnosis for identifying GCSE. Sensitivity and specificity calculations were weighted according to the distribution of seizure cases in the overall population. We performed a descriptive analysis of records with an incorrect EMS diagnosis of GCSE or seizure. Of 38,995 total records for seizure, there were 3401 (8.7%) seizure-active cases, 12,478 (32.0%) seizure-NOS cases, and 23,116 (59.4%) seizure-post cases. An EMS diagnosis of “seizure-active” had a PPV of 65.0% (95% CI 54.8–74.3), sensitivity of 54.6% (95% confidence interval [CI] 39.3–69.0), and specificity of 96.6% (95% CI 95.1–97.6) for capturing GCSE. Limiting the case definition to patients who received an EMS diagnosis of “seizure-active” and were treated with a benzodiazepine increased the PPV (80.2%; 95% CI 69.9–88.2) and specificity (99.3%; 95% CI 98.7–99.6) while the sensitivity decreased (25.1%; 95% CI 17.0–35.3). Across the 300 records reviewed, there were 19 (6.3%) patients who had a non-seizure related diagnosis including non-epileptic spells (7 records), altered mental status (8 records), tremors (2 records), anxiety (1 record), and stroke (1 record). EMS diagnostic impressions have reasonable PPV and specificity but low sensitivity for GCSE. Improved coding algorithms and training will allow for improved benchmarking, quality improvement, and research about this neurologic emergency.
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影响因子：
5.6
作者：
Claassen, Jan;Mayer, Stephan A
通讯作者：
Mayer, Stephan A
影响因子：
3.2
作者：
Pallin, Daniel J.;Goldstein, Joshua N.;Camargo, Carlos A., Jr.
通讯作者：
Camargo, Carlos A., Jr.
影响因子：
2.2
作者：
Lv, Rui-Juan;Wang, Qun;Shao, Xiao-Qiu
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Shao, Xiao-Qiu
DOI：
10.1080/10903129808958866
发表时间：
1998-07-01
期刊：
Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
影响因子：
--
作者：
Smith, W S;Isaacs, M;Corry, M D
通讯作者：
Corry, M D
影响因子：
5.6
作者：
Lowenstein, DH;Bleck, T;Macdonald, RL
通讯作者：
Macdonald, RL