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首页> 外文期刊>Canadian Journal of Emergency Medicine >Effect of online medical control on prehospital Code Stroke triage
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Effect of online medical control on prehospital Code Stroke triage

机译：在线医疗控制对院前中风分类的影响

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Objective:Prehospital Code Stroke triage has the potential to overwhelm stroke centres by falsely identifying patients as eligible for fibrinolysis. We sought to determine whether online medical control (whereby paramedics contact the medical control physician before a Code Stroke triage is assigned) reduced the proportion of false-positive Code Stroke patients.Methods:Following the introduction of a protocol for prehospital Code Stroke triage in an urban centre, online medical control alternated with off-line medical control (whereby paramedics implement Code Stroke triage independently) over 4 discreet intervals. We reviewed data for patients triaged to 3 regional stroke centres to compare the proportion of false-positive Code Stroke patients during online versus off-line medical control. We predefined false positives as patients triaged as Code Stroke who had symptoms discovered on awakening, were last seen in their usual state of health greater than 2 hours before assessment or had a final diagnosis other than stroke.Results:The proportion of false positives was lower during online medical control (31% v. 42%, p = 0.003). This was explained by a lower proportion of patients whose symptoms were discovered on awakening (8% v. 14%, p < 0.001) and who were last seen in their usual state of health greater than 2 hours before assessment (22% v. 32%, p = 0.005). A final diagnosis of stroke was similar in the 2 groups (77% v. 79%, p = 0.39), as was the proportion of patients receiving fibrinolysis (35% v. 33%, p = 0.72). Eighteen percent of patients were denied Code Stroke triage during online control, most commonly because of the time of symptom onset. Conclusion:Online medical control is associated with a reduced proportion of false-positive Code Stroke triage.
机译：目的：院前代码卒中分流有可能通过错误地识别出符合纤溶标准的患者而淹没卒中中心。我们试图确定在线医疗控制（在进行代码中风分类之前，医护人员应联系医疗控制医生）是否减少了假阳性代码中风患者的比例。方法：在医院中引入院前代码中风分类的方案之后。在城市中心，在线医疗控制与离线医疗控制（因此，医护人员独立执行Code Stroke分类）间隔4个谨慎的时间间隔。我们回顾了在3个区域性卒中中心分类的患者的数据，以比较在线和离线医疗控制中假阳性的Code Stroke患者的比例。我们对误诊为Code Stroke的患者进行了预定义的误报，这些患者在醒来时发现了症状，在评估前超过2小时最后一次处于正常的健康状态，或者除中风外最终做出了诊断。结果：误报的比例较低在线医疗控制期间（31％对42％，p = 0.003）。造成这种现象的原因是，醒来时发现症状的患者比例较低（8％vs. 14％，p <0.001），并且在评估前超过2小时处于正常健康状态的患者最后一次见面（22％vs. 32） ％，p = 0.005）。两组中风的最终诊断相似（77％vs. 79％，p = 0.39），接受纤溶的患者比例（35％vs. 33％，p = 0.72）。在线控制期间，有18％的患者被拒绝进行代码卒中分类，最常见的原因是症状发作的时间。结论：在线医疗控制与假阳性代码卒中分类的比例降低有关。

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