The clinical consequences of a pre-hospital diagnosis of stroke by the emergency medical service system. A pilot study.
The clinical consequences of a pre-hospital diagnosis of stroke by the emergency medical service system. A pilot study.
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DOI：
10.1186/1757-7241-20-48
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发表时间：
2012-07-10
期刊：
影响因子：
--
通讯作者：
Hansson PO
中科院分区：
文献类型：
--
作者：
Wennman I;Klittermark P;Herlitz J;Lernfelt B;Kihlgren M;Gustafsson C;Hansson PO
对于大多数急性卒中患者，从出现症状到到达卒中单元仍有相当长的延迟。本研究的目的是描述急诊医疗服务（EMS）护士在诊断准确性和从拨打112直到到达卒中单元的延迟方面对卒中进行院前诊断的可行性。在2008年9月至2009年11月期间，EMS工作人员绕过急诊科，直接将院前环境中假定急性卒中的一部分患者送入卒中单元。创建了一个对照组，与许多背景变量相匹配。直接入院组53例，对照组49例。直接入院组从呼叫救护车到到达卒中单元的中位延迟时间为54分钟，对照组为289分钟（p < 0.0001）。在直接入院组和对照组之间的比较中，最终诊断为卒中、短暂性脑缺血发作（TIA）或既往卒中后遗症的患者比例分别为85%和90%（NS）。在事件发生前住在家里的卒中患者中，3个月后住在家里的患者百分比分别为71%和62%（NS）。在一项试点研究中，EMS护士对卒中进行院前诊断的概念与卒中相关诊断的相对较高的诊断准确性和到达卒中单元的短暂延迟相关。这些数据需要在更大规模的研究中得到证实，同时评估临床结果，如果可能的话，还需要评估患者的满意度。
There is still a considerable delay between the onset of symptoms and arrival at a stroke unit for most patients with acute stroke. The aim of the study was to describe the feasibility of a pre-hospital diagnosis of stroke by an emergency medical service (EMS) nurse in terms of diagnostic accuracy and delay from dialing 112 until arrival at a stroke unit. Between September 2008 and November 2009, a subset of patients with presumed acute stroke in the pre-hospital setting were admitted by EMS staff directly to a stroke unit, bypassing the emergency department. A control group, matched for a number of background variables, was created. In all, there were 53 patients in the direct admission group, and 49 patients in the control group. The median delay from calling for an ambulance until arrival at a stroke unit was 54 minutes in the direct admission group and 289 minutes in the control group (p < 0.0001). In a comparison between the direct admission group and the control group, a final diagnosis of stroke, transient ischemic attack (TIA) or the sequelae of prior stroke was found in 85% versus 90% (NS). Among stroke patients who lived at home prior to the event, the percentage of patients that were living at home after 3 months was 71% and 62% respectively (NS). In a pilot study, the concept of a pre-hospital diagnosis of stroke by an EMS nurse was associated with relatively high diagnostic accuracy in terms of stroke-related diagnoses and a short delay to arrival at a stroke unit. These data need to be confirmed in larger studies, with a concomitant evaluation of the clinical consequences and, if possible, the level of patient satisfaction as well.
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