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Paramedics accurately apply the pediatric assessment triangle to drive management

机译：医护人员准确地将儿科评估三角应用于驾驶管理

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Objective. To provide an evaluation of the Pediatric Assessment Triangle (PAT) as an assessment tool for use by paramedic providers in the prehospital care of pediatric patients.Methods. Paramedics from Los Angeles Fire Department (LAFD) received training in the Pediatric Education for Prehospital Professionals (PEPP) course, PAT study procedures, and completed training in applying the PAT to assess children 0-14 years of age. A convenience sample of LAFD paramedic assessments of the pediatric patients transported to 29 participating institutions, over an 18-month period ending July 2010, were eligible for inclusion. Patients who were not transported were excluded from the study, as were the assessments of children with special health-care needs (CSHCN). PAT Study Forms, emergency medical services (EMS) report forms, and emergency department (ED) and hospital charts were entered into a secure database. Two study investigators, blinded to paramedic PAT assessment, reviewed hospital charts and determined the category of illness or injury.Results. A total of 1,552 PAT Study Forms were collected. Overall, 1,168 of the patient (75%) assessments met inclusion criteria, were transported, and had all three data points (PAT Study Form, paramedic EMS report form, and ED/hospital chart) available for analysis. When paramedics used the PAT to identify abnormalities in the three arms of the triangle (PAT Paramedic Pattern) and applied that pattern to form a general impression (PAT Paramedic Impression), the agreement resulted in a κ coefficient of 0.93 [95% CI: 0.91-0.95]. The PAT paramedic impression was congruent with field management, as the majority of patients received consistent interventions with local EMS protocols. The PAT Paramedic Impression for instability demonstrated a sensitivity of 77.4% [95% CI: 72.6-81.5%], a specificity of 90.0% [95% CI: 87.1-91.5%] with a positive likelihood ratio (LR+) of 7.7 [95% CI: 5.9-9.1] and a negative likelihood ratio (LR-) of 0.3 [95% CI: 0.2-0.3].Conclusion. The PAT is a rapid assessment tool that can be readily and reliably used by paramedics in the prehospital setting. The PAT should be used in conjunction with other assessments but can safely drive initial field management.
机译：目的。提供对儿科评估三角（PAT）的评估，将其作为评估工具，供医护人员在儿科患者的院前护理中使用。洛杉矶消防局（LAFD）的医护人员接受了院前专业人员儿科教育（PEPP）课程，PAT学习程序的培训，并完成了应用PAT评估0-14岁儿童的培训。截至2010年7月的18个月内，对转移至29个参与机构的儿科患者进行了LAFD辅助医疗评估的便利样本，符合纳入条件。未转运的患者以及有特殊保健需求的儿童（CSHCN）的评估均被排除在研究之外。 PAT学习表，急诊医疗服务（EMS）报告表，急诊科（ED）和医院病历已输入安全数据库中。两名研究人员不愿接受护理人员PAT评估，检查了医院病历表并确定了疾病或受伤的类别。总共收集了1,552个PAT研究表格。总体而言，有1168例患者（占75％）评估符合入选标准，已经过运输，并且所有三个数据点（PAT研究表格，辅助医疗EMS报告表格和ED /医院病历）可供分析。当医护人员使用PAT识别三角形的三个臂中的异常（PAT医护人员模式）并应用该模式以形成总体印象（PAT医护人员印象）时，该协议得出的κ系数为0.93 [95％CI：0.91 -0.95]。 PAT护理人员的印象与现场管理一致，因为大多数患者接受了当地EMS方案的一致干预。 PAT医护人员对不稳定的印象显示灵敏度为77.4％[95％CI：72.6-81.5％]，特异性为90.0％[95％CI：87.1-91.5％]，阳性似然比（LR +）为7.7 [95] ％CI：5.9-9.1]，负似然比（LR-）为0.3 [95％CI：0.2-0.3]。结论。 PAT是一种快速评估工具，医护人员可以在院前环境中轻松，可靠地使用它。 PAT应该与其他评估结合使用，但可以安全地推动初始现场管理。

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