Abstract WP298: Communication Center Guided Prehospital Stroke Assessment Scoring has High Inter-rater Agreement
| Autor: | Abimbola Fadairo, Joe E. Acker, Melissa Gazi, Toby Gropen, Michael Minor |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Advanced and Specialized Nursing
medicine.medical_specialty Stroke patient business.industry medicine.disease Inter-rater reliability Physical medicine and rehabilitation Medicine Center (algebra and category theory) Neurology (clinical) Cardiology and Cardiovascular Medicine business Stroke Large vessel occlusion |
| Zdroj: | Stroke. 50 |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/str.50.suppl_1.wp298 |
| Popis: | Introduction: We are prospectively validating a model of communication center guided prehospital identification of stroke patients with large vessel occlusion (LVO). Goal: Assess the inter-rater agreement between a Vascular Neurologist and Alabama Trauma Communication Center (ATCC) personnel in diagnostic classification of stroke patients. Methods: The ATCC is staffed by paramedic-trained dispatchers who field calls from Emergency Medical Service (EMS) responders and maintain up-to-the-minute status of hospitals and resources 24/7. We trained ATCC personnel in stroke pathology, pathophysiology, appropriate patient selection for thrombolytic and endovascular therapies; and the previously derived 6 point Emergency Medical Stroke Assessment (EMSA). ATCC personnel guided EMS responders in the Birmingham Regional Emergency Medical Services System (BREMSS), and paged-out a hospital stroke prenotification that included specific EMSA scale items (gaze, facial droop, arm drift, leg drift, naming, and repetition). All interactions between the ATCC and EMS responders were recorded, allowing review of audio files and ongoing quality improvement. ATCC personnel and a vascular neurologist separately reviewed recordings and assigned scores to each patient according to the deficit stated by the EMS. To determine inter-rater reliability we utilized the Kappa statistic with a significance level of 0.05, and 95% confidence intervals (CI). Results: We sampled a total of 146 patients. We observed statistically significant agreement between the raters for all EMSA components, with 71% (CI=45-97%, p Conclusion: We conclude that there is moderate to substantial agreement in most stroke assessment items by a paramedic staffed communication center and a vascular neurologist. There was only fair inter-rater agreement for repetition. Paramedic-trained dispatchers can reliably guide EMS responders and score the Emergency Medical Stroke Assessment. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|