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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Prehospital Stroke Identification: Factors Associated with Diagnostic Accuracy
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Prehospital Stroke Identification: Factors Associated with Diagnostic Accuracy

机译：预孢子中风识别：与诊断准确性相关的因素

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Background: Stroke patients misdiagnosed by emergency medical services (EMS) providers have been shown to receive delayed in-hospital care. We aim at determining the diagnostic accuracy of Fire Department of New York (FDNY) EMS providers for stroke and identifying potential reasons for misdiagnosis. Methods: Prehospital care reports of all patients transported by FDNY EMS to 3 hospitals from January 1, 2010, to December 31, 2011, were compared against the American Heart Association Get With The Guidelines (GWTG) database (reference standard) for the diagnosis of stroke. Age-adjusted logistic regression models were generated to explore prehospital patient characteristics which are associated with stroke misdiagnosis. Results: Of 72,984 patient transports during the study period, 750 had a GWTG diagnosis of stroke, 468 (62%) of which were identified correctly in the field and 282 (38%) were missed. An additional 268 patients were misdiagnosed as stroke when in fact they had an alternative diagnosis. Overall sensitivity was 62.4% (95% confidence interval [CI], 58.9-65.8) and specificity was 99.6% (95% CI, 99.6-99.7). No patients who presented with unilateral weakness, facial weakness, or speech problems were missed, whereas patients with atypical complaints like general malaise, dizziness, and headache were more likely to be missed. Seizures led the EMS providers to both overcall a stroke and miss the diagnosis. Conclusions: FDNY EMS care providers missed more than a third of stroke cases. Seizures and other atypical presentations contribute significantly to stroke misdiagnosis in the field. Our findings highlight the need for better prehospital stroke identification methods. (C) 2015 by National Stroke Association
机译：背景：脑卒中患者被紧急医疗服务（EMS）提供者误诊已被证明可接受延迟住院护理。我们的目标是确定纽约火灾部门（FDNY）EMS供应商的诊断准确性，并确定误诊的潜在原因。方法：对2010年1月1日至2011年1月1日至2011年12月31日，FDNY EMS运输到3家医院的所有患者的预科护理报告与美国心脏协会获得了指导方针（GWTG）数据库（参考标准）进行诊断中风。产生年龄调整后的逻辑回归模型以探讨与中风误诊相关的预孢子患者特征。结果：在研究期间的72,984例患者运输中，750例诊断卒中的GWTG诊断，其中468（62％）在该领域正确鉴定，282（38％）错过了。额外的268名患者被误诊，因为事实上他们有替代诊断。总体敏感性为62.4％（95％置信区间[CI]，58.9-65.8）和特异性为99.6％（95％CI，99.6-99.7）。没有错过那些呈现单方面弱点，面部弱点或讲话问题的患者，而非典型投诉的患者更有可能错过普通萎靡不振，头晕和头痛。癫痫发作带领EMS提供商覆盖跨越中风并错过诊断。结论：FDNY EMS护理提供商错过了超过三分之一的中风病例。癫痫发作和其他非典型陈述在脑卒中中风误诊中有显着贡献。我们的研究结果突出了更好的预孢子中风识别方法的需求。 （c）2015年国家冲程协会

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