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Accuracy of Emergency Medical Services Dispatcher and Crew Diagnosis of Stroke in Clinical Practice

BACKGROUND: Accurate recognition of stroke symptoms by Emergency Medical Services (EMS) is necessary for timely care of acute stroke patients. We assessed the accuracy of stroke diagnosis by EMS in clinical practice in a major US city. METHODS AND RESULTS: Philadelphia Fire Department data were merg...

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Autores principales: Jia, Judy, Band, Roger, Abboud, Michael E., Pajerowski, William, Guo, Michelle, David, Guy, Mechem, C. Crawford, Messé, Steven R., Carr, Brendan G., Mullen, Michael T.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5603652/
https://www.ncbi.nlm.nih.gov/pubmed/28959230
http://dx.doi.org/10.3389/fneur.2017.00466
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author Jia, Judy
Band, Roger
Abboud, Michael E.
Pajerowski, William
Guo, Michelle
David, Guy
Mechem, C. Crawford
Messé, Steven R.
Carr, Brendan G.
Mullen, Michael T.
author_facet Jia, Judy
Band, Roger
Abboud, Michael E.
Pajerowski, William
Guo, Michelle
David, Guy
Mechem, C. Crawford
Messé, Steven R.
Carr, Brendan G.
Mullen, Michael T.
author_sort Jia, Judy
collection PubMed
description BACKGROUND: Accurate recognition of stroke symptoms by Emergency Medical Services (EMS) is necessary for timely care of acute stroke patients. We assessed the accuracy of stroke diagnosis by EMS in clinical practice in a major US city. METHODS AND RESULTS: Philadelphia Fire Department data were merged with data from a single comprehensive stroke center to identify patients diagnosed with stroke or TIA from 9/2009 to 10/2012. Sensitivity and positive predictive value (PPV) were calculated. Multivariable logistic regression identified variables associated with correct EMS diagnosis. There were 709 total cases, with 400 having a discharge diagnosis of stroke or TIA. EMS crew sensitivity was 57.5% and PPV was 69.1%. EMS crew identified 80.2% of strokes with National Institutes of Health Stroke Scale (NIHSS) ≥5 and symptom duration <6 h. In a multivariable model, correct EMS crew diagnosis was positively associated with NIHSS (NIHSS 5–9, OR 2.62, 95% CI 1.41–4.89; NIHSS ≥10, OR 4.56, 95% CI 2.29–9.09) and weakness (OR 2.28, 95% CI 1.35–3.85), and negatively associated with symptom duration >270 min (OR 0.41, 95% CI 0.25–0.68). EMS dispatchers identified 90 stroke cases that the EMS crew missed. EMS dispatcher or crew identified stroke with sensitivity of 80% and PPV of 50.9%, and EMS dispatcher or crew identified 90.5% of patients with NIHSS ≥5 and symptom duration <6 h. CONCLUSION: Prehospital diagnosis of stroke has limited sensitivity, resulting in a high proportion of missed stroke cases. Dispatchers identified many strokes that EMS crews did not. Incorporating EMS dispatcher impression into regional protocols may maximize the effectiveness of hospital destination selection and pre-notification.
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spelling pubmed-56036522017-09-28 Accuracy of Emergency Medical Services Dispatcher and Crew Diagnosis of Stroke in Clinical Practice Jia, Judy Band, Roger Abboud, Michael E. Pajerowski, William Guo, Michelle David, Guy Mechem, C. Crawford Messé, Steven R. Carr, Brendan G. Mullen, Michael T. Front Neurol Neuroscience BACKGROUND: Accurate recognition of stroke symptoms by Emergency Medical Services (EMS) is necessary for timely care of acute stroke patients. We assessed the accuracy of stroke diagnosis by EMS in clinical practice in a major US city. METHODS AND RESULTS: Philadelphia Fire Department data were merged with data from a single comprehensive stroke center to identify patients diagnosed with stroke or TIA from 9/2009 to 10/2012. Sensitivity and positive predictive value (PPV) were calculated. Multivariable logistic regression identified variables associated with correct EMS diagnosis. There were 709 total cases, with 400 having a discharge diagnosis of stroke or TIA. EMS crew sensitivity was 57.5% and PPV was 69.1%. EMS crew identified 80.2% of strokes with National Institutes of Health Stroke Scale (NIHSS) ≥5 and symptom duration <6 h. In a multivariable model, correct EMS crew diagnosis was positively associated with NIHSS (NIHSS 5–9, OR 2.62, 95% CI 1.41–4.89; NIHSS ≥10, OR 4.56, 95% CI 2.29–9.09) and weakness (OR 2.28, 95% CI 1.35–3.85), and negatively associated with symptom duration >270 min (OR 0.41, 95% CI 0.25–0.68). EMS dispatchers identified 90 stroke cases that the EMS crew missed. EMS dispatcher or crew identified stroke with sensitivity of 80% and PPV of 50.9%, and EMS dispatcher or crew identified 90.5% of patients with NIHSS ≥5 and symptom duration <6 h. CONCLUSION: Prehospital diagnosis of stroke has limited sensitivity, resulting in a high proportion of missed stroke cases. Dispatchers identified many strokes that EMS crews did not. Incorporating EMS dispatcher impression into regional protocols may maximize the effectiveness of hospital destination selection and pre-notification. Frontiers Media S.A. 2017-09-14 /pmc/articles/PMC5603652/ /pubmed/28959230 http://dx.doi.org/10.3389/fneur.2017.00466 Text en Copyright © 2017 Jia, Band, Abboud, Pajerowski, Guo, David, Mechem, Messé, Carr and Mullen. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neuroscience
Jia, Judy
Band, Roger
Abboud, Michael E.
Pajerowski, William
Guo, Michelle
David, Guy
Mechem, C. Crawford
Messé, Steven R.
Carr, Brendan G.
Mullen, Michael T.
Accuracy of Emergency Medical Services Dispatcher and Crew Diagnosis of Stroke in Clinical Practice
title Accuracy of Emergency Medical Services Dispatcher and Crew Diagnosis of Stroke in Clinical Practice
title_full Accuracy of Emergency Medical Services Dispatcher and Crew Diagnosis of Stroke in Clinical Practice
title_fullStr Accuracy of Emergency Medical Services Dispatcher and Crew Diagnosis of Stroke in Clinical Practice
title_full_unstemmed Accuracy of Emergency Medical Services Dispatcher and Crew Diagnosis of Stroke in Clinical Practice
title_short Accuracy of Emergency Medical Services Dispatcher and Crew Diagnosis of Stroke in Clinical Practice
title_sort accuracy of emergency medical services dispatcher and crew diagnosis of stroke in clinical practice
topic Neuroscience
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5603652/
https://www.ncbi.nlm.nih.gov/pubmed/28959230
http://dx.doi.org/10.3389/fneur.2017.00466
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