Paramedic Diagnosis of Stroke
| Autor: | Christopher F. Bladin, Kelly Coughlan, Janet Bray, Bill Barger |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Male
Emergency Medical Services medicine.medical_specialty Time Factors Victoria Cross-sectional study Ambulances Allied Health Personnel Severity of Illness Index Severity of illness Humans Medicine Stroke Aged Aged 80 and over Advanced and Specialized Nursing Discharge diagnosis business.industry Stroke scale Medical screening Reproducibility of Results medicine.disease Cross-Sectional Studies Physical therapy Female Neurology (clinical) Cardiology and Cardiovascular Medicine business |
| Zdroj: | Stroke. 41:1363-1366 |
| ISSN: | 1524-4628 0039-2499 |
| DOI: | 10.1161/strokeaha.109.571836 |
| Popis: | Background and Purpose— Recent evidence suggests the Cincinnati Prehospital Stroke Scale is ineffectively used and lacks sensitivity and specificity. Melbourne (Australia) paramedics have been using the Melbourne Ambulance Stroke Screen (MASS) since 2005. The aim of this study was to review the real-world use of MASS 3 years after citywide implementation. Methods— Two groups of consecutively admitted patients to an Australian hospital between January and May 2008 were used: (1) patients for whom paramedics performed MASS; and (2) patients with a discharge diagnosis of stroke or transient ischemic attack. Use of MASS was examined for all transports and for patients diagnosed with stroke or transient ischemic attack. The sensitivity and specificity of paramedic diagnosis, MASS, and Cincinnati Prehospital Stroke Scale were calculated. Paramedic diagnosis of stroke among patients with stroke was statistically compared with those obtained immediately post-MASS implementation in 2002. Results— For the study period, MASS was performed for 850 (16%) of 5286 emergency transports, including 199 of 207 (96%) patients with confirmed stroke and transient ischemic attack. In patients in whom MASS was performed (n=850), the sensitivity of paramedic diagnosis of stroke (93%, 95% CI: 88% to 96%) was higher than the MASS (83%, 95% CI: 77% to 88%, P =0.003) and equivalent to Cincinnati Prehospital Stroke Scale (88%, 95% CI: 83% to 92%, P =0.120), whereas the specificity of the paramedic diagnosis of stroke (87%, 95% CI: 84% to 89%) was equivalent to MASS (86%, 95% CI: 83% to 88%, P =0.687) and higher than Cincinnati Prehospital Stroke Scale (79%, 95% CI: 75% to 82%, P P =0.19). Conclusion— In our experience, paramedics have successfully incorporated MASS into the assessment of neurologically compromised patients. The initial improvement to the paramedics’ diagnosis of stroke with MASS was sustained 3 years after citywide implementation. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|