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Family physician decisions following stroke symptom onset and delay times to ambulance call

机译：中风症状发作后家庭医生的决定以及急救时间的延迟

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Background For stroke patients, calling an ambulance has been shown to be associated with faster times to hospital than contacting a family physician. However little is known about the impact of decisions made by family physicians on delay times for stroke patients once they have been called. We aimed to test the hypotheses that among ambulance transported stroke patients: ? Factors associated with first calling a family physician, could be identified. ? Time to ambulance call will be longer when a family physician is first contacted. ? Medical examination prior to the ambulance call will be associated with longer delay times. Methods For 6 months in 2004, all ambulance-transported stroke patients who presented from a defined region in Melbourne, Australia to one of three hospitals were assessed. Ambulance and hospital records were analysed. The patient and the person who called the ambulance were interviewed to obtain their description of the stroke event. Results 198 patients were included in the study. In 32% of cases an ambulance was first called. No demographic or situational factors were associated with first calling a doctor. Patients with a history of stroke or TIA were less likely to call a doctor following symptom onset (p = 0.01). Patients with a severe stroke (Glasgow Coma Scale < 9) never called a doctor first. When a family physician was contacted (22% of cases), the time to ambulance call was significantly longer than when an ambulance was first called (p = 0.0018) (median 143 and 44 minutes, respectively). In 36% of calls to a family physician, the doctor elected to first examine the patient. Time to ambulance call was shorter when the doctor vetted the call and advised the caller to immediately call an ambulance (45%) (median 412 and 92 minutes respectively: p = 0.06). Conclusion Time delays to ambulance call were significantly longer for stroke patients when a family physician was first contacted. Further extensive delays were experienced by patients when the family physician elected to examine the patient. Family physicians and their staff have an important role to play in averting potential delays for stroke patients by screening calls and providing immediate advice to "call an ambulance".
机译：背景技术对于中风患者来说，呼叫救护车与联系家庭医生相比，可以更快地住院。然而，关于中风患者一旦被召唤，家庭医生做出的决定对他们延误时间的影响知之甚少。我们旨在检验救护车运送的中风患者的假设：可以确定与首次致电家庭医生有关的因素。 ？首次联系家庭医生时，拨打救护车的时间会更长。 ？救护车呼叫前的体检将导致更长的延迟时间。方法在2004年的6个月中，对所有从澳大利亚墨尔本的指定地区就诊到三所医院之一的救护车中风患者进行了评估。分析了救护车和医院的记录。对病人和叫救护车的人进行了采访，以获取他们对中风事件的描述。结果198名患者被纳入研究。在32％的情况下，首先叫了一辆救护车。没有人口统计学或情况因素与第一次就医有关。有中风或TIA病史的患者在症状发作后较少去看医生（p = 0.01）。患有严重中风（格拉斯哥昏迷评分<9）的患者从来没有先去看医生。当联系家庭医生时（占病例的22％），呼叫救护车的时间明显比第一次呼叫救护车的时间长（p = 0.0018）（分别为143分钟和44分钟）。在致电给家庭医生的电话中，有36％的医生选择首先检查病人。当医生审核了该呼叫并建议呼叫者立即呼叫一辆救护车时（45％），救护车呼叫的时间缩短了（中位数为412分钟和92分钟：p = 0.06）。结论首次联系家庭医生时，中风患者的救护车呼叫延迟时间明显更长。当家庭医生选择检查病人时，病人经历了进一步的延误。家庭医生及其员工在筛选中风和提供即时建议以“呼叫救护车”方面，在避免中风患者的潜在延误中发挥着重要作用。

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