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首页> 外文期刊>Prehospital emergency care >RECOGNITION OF STROKE BY EMS IS ASSOCIATED WITH IMPROVEMENT IN EMERGENCY DEPARTMENT QUALITY MEASURES
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RECOGNITION OF STROKE BY EMS IS ASSOCIATED WITH IMPROVEMENT IN EMERGENCY DEPARTMENT QUALITY MEASURES

机译：EMS对冲程的识别与应急部门质量措施的改进有关

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Objective: Hospital arrival via Emergency Medical Services ( EMS) and EMS prenotification are associated with faster evaluation and treatment of stroke. We sought to determine the impact of diagnostic accuracy by prehospital providers on emergency department quality measures. Methods: A retrospective study was performed of patients presenting via EMS between September 2009 and December 2012 with a discharge diagnosis of transient ischemic attack ( TIA), ischemic stroke ( IS), or intracerebral hemorrhage ( ICH). Hospital and EMS databases were used to determine EMS impression, prehospital and in-hospital time intervals, EMS prenotification, NIH stroke scale ( NIHSS), symptom duration, and thrombolysis rate. Results: 399 cases were identified: 14.5% TIA, 67.2% IS, and 18.3% ICH. EMS providers correctly recognized 57.6% of cases. Compared to cases missed by EMS, correctly recognized cases had longer median on-scene time ( 17 vs. 15 min, p = 0.01) but shorter transport times ( 12 vs. 15 min, p = 0.001). Cases correctly recognized by EMS were associated with shorter door-to-physician time ( 4 vs. 11 min, p < 0.001) and shorter door-to-CT time ( 23 vs. 48 min, p < 0.001). These findings were independent of age, NIHSS, symptom duration, and EMS prenotification. Patients with ischemic stroke correctly recognized by EMS were more likely to receive thrombolytic therapy, independent of age, NIHSS, symptom duration both with and without prenotification. Conclusion: Recognition of stroke by EMS providers was independently associated with faster door-to-physician time, faster door-to-CT time, and greater odds of receiving thrombolysis. Quality initiatives to improve EMS recognition of stroke have the potential to improve hospital-based quality of stroke care.
机译：目的：通过紧急医疗服务（EMS）到达医院并通过EMS预先通知可以更快地评估和治疗中风。我们试图确定院前提供者的诊断准确性对急诊科质量措施的影响。方法：回顾性研究了2009年9月至2012年12月间通过EMS出院的，诊断为短暂性脑缺血发作（TIA），缺血性中风（IS）或脑出血（ICH）的患者。医院和EMS数据库用于确定EMS印象，院前和院内时间间隔，EMS预先通知，NIH中风量表（NIHSS），症状持续时间和溶栓率。结果：鉴定出399例：TIA为14.5％，IS为67.2％和ICH为18.3％。 EMS提供者正确识别了57.6％的案件。与EMS遗漏的病例相比，正确识别的病例的中位现场时间更长（17 vs. 15分钟，p = 0.01），但运输时间更短（12 vs. 15 min，p = 0.001）。 EMS正确识别的病例与门诊时间较短（4比11分钟，p <0.001）和门诊时间较短（23 vs. 48分钟，p <0.001）相关。这些发现与年龄，NIHSS，症状持续时间和EMS预先通知无关。 EMS正确识别的缺血性卒中患者更有可能接受溶栓治疗，而不论年龄，NIHSS，症状持续时间有无预告。结论：EMS提供者对中风的识别与门诊时间，门诊时间和门诊溶栓率的增加独立相关。改善EMS对中风的认识的质量计划有可能提高医院中风治疗的质量。

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