Prehospital dispatch assessment of stroke.
ABSTRACT This study is to determine the assessment accuracy for the diagnosis of stroke by EMS dispatchers and paramedics compared to emergency physicians (EPs). Of the 191 patients who met inclusion criteria, dispatchers assessed 133 as having a stroke; EPs agreed in 67 (50%) cases. Paramedics assessed 100 patients as having stroke; EPs agreed in 70 (70%) cases. Dispatcher and paramedic sensitivity for diagnosing stroke was 61% and 64%, respectively; specificity was 20% and 63% respectively. Sensitivity for the detection of acute stroke was nearly identical between EMS dispatchers and on-scene paramedics; overall agreement with emergency physician diagnosis was moderate.
Article: Comparative evaluation of stroke triage algorithms for emergency medical dispatchers (MeDS): prospective cohort study protocol.[show abstract] [hide abstract]
ABSTRACT: Stroke is a major cause of death and leading cause of disability in the United States. To maximize a stroke patient's chances of receiving thrombolytic treatment for acute ischemic stroke, it is important to improve prehospital recognition of stroke. However, it is known from published reports that emergency medical dispatchers (EMDs) using Card 28 of the Medical Priority Dispatch System protocols recognize stroke poorly. Therefore, to improve EMD's recognition of stroke, the National Association of Emergency Medical Dispatchers recently designed a new diagnostic stroke tool (Cincinnati Stroke Scale -CSS) to be used with Card 28. The objective of this study is to determine whether the addition of CSS improves diagnostic accuracy of stroke triage. This prospective experimental study will be conducted during a one-year period in the 911 call center of Santa Clara County, CA. We will include callers aged ≥ 18 years with a chief complaint suggestive of stroke and second party callers (by-stander or family who are in close proximity to the patient and can administer the tool) ≥ 18 years of age. Life threatening calls will be excluded from the study. Card 28 questions will be administered to subjects who meet study criteria. After completion of Card 28, CSS tool will be administered to all calls. EMDs will record their initial assessment of a cerebro-vascular accident (stroke) after completion of Card 28 and their final assessment after completion of CSS. These assessments will be compared with the hospital discharge diagnosis (ICD-9 codes) recorded in the Office of Statewide Health Planning and Development (OSHPD) database after linking the EMD database and OSHPD database using probabilistic linkage. The primary analysis will compare the sensitivity of the two stroke protocols using logistic regression and generalizing estimating equations to account for clustering by EMDs. To detect a 15% difference in sensitivity between the two groups with 80% power, we will enroll a total of 370 subjects in this trial. A three week pilot study was performed which demonstrated the feasibility of implementation of the study protocol.BMC Neurology 01/2011; 11:14. · 2.17 Impact Factor