An interventional study to improve paramedic diagnosis of stroke.
An interventional study to improve paramedic diagnosis of stroke.
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DOI：
10.1080/10903120590962382
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发表时间：
2005-07-01
期刊：
影响因子：
--
通讯作者：
Bladin, Christopher
中科院分区：
文献类型：
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作者：
Bray, Janet E;Martin, Jenepher;Bladin, Christopher
目的：更快地获得中风治疗（FAST）研究的目的是确定教育干预的效果和使用院前中风工具对护理人员的中风diagnosis of stroke.METHODS：护理人员在急诊医疗服务单位服务的大学教学医院分为两组：FAST研究护理人员（n = 18）和非FAST研究护理人员（n = 43）。FAST研究护理人员接受卒中教育和指导，使用院前卒中评估工具[墨尔本救护车卒中筛查（MASS）]辅助卒中诊断。基于最终的医院诊断，在干预前后的12个月内比较两组护理人员卒中诊断的敏感性。在接受卒中教育课程并使用MASS工具后，患者的死亡率（95%置信区间[CI]：63%至88%）降至94%（95% CI：86%至98%）（p = 0.006）。非研究护理人员的卒中诊断无变化，为78%（95% CI：71%至84%）至80%（95% CI：72%至87%）（p = 0.695）。预先通知即将到达急诊科与急诊科的优先级较高，随后的时间较短的门到医疗审查（15分钟vs. 31分钟，p < 0.001）和门到计算机断层扫描（CT）扫描结论：有针对性的卒中教育和使用简单的临床工具可以显著提高护理人员在院前环境中对卒中的诊断敏感性。准确的诊断结合预先通知即将到来的中风患者将允许集中和及时应用资源管理急性中风。
OBJECTIVE: The aim of the Faster Access to Stroke Therapy (FAST) study was to determine the effect of educational intervention and the use of a prehospital stroke tool on the paramedic diagnosis of stroke.METHODS: Paramedics in emergency medical service units servicing a university teaching hospital were divided into two groups: FAST study paramedics (n = 18) and non-FAST study paramedics (n = 43). The FAST study paramedics received stroke education and instruction in the use of a prehospital stroke assessment tool [Melbourne Ambulance Stroke Screen (MASS)] to assist in stroke diagnosis. Based on final hospital diagnosis, the sensitivities of paramedic stroke diagnosis in the two groups were compared for a 12-month period before and after the intervention.RESULTS: The sensitivity for the FAST study paramedics in identifying stroke improved from 78% (95% confidence interval [CI]: 63% to 88%) to 94% (95% CI: 86% to 98%) (p = 0.006) after receiving the stroke education session and with use of the MASS tool. There was no change in stroke diagnosis for the non-study paramedics 78% (95% CI: 71% to 84%) to 80% (95% CI: 72% to 87%) (p = 0.695). Pre-notification of impending arrival to the emergency department was associated with higher-priority triage in the emergency department, and subsequent shorter times for door to medical review (15 min vs. 31 min, p < 0.001) and door to computed tomography (CT) scanning (94 min vs. 144 min, p < 0.001).CONCLUSIONS: Targeted stroke education and the use of a simple clinical tool can significantly improve the diagnostic sensitivity of stroke by paramedics in the prehospital setting. Accurate diagnosis combined with pre-notification of the pending arrival of stroke patients will allow for the focused and timely application of resources for the management of acute stroke.