Accuracy of working diagnosis by paramedics for patients presenting with dyspnoea

Christie, Andrew; Costa-Scorse, Brenda; Nicholls, M.; Jones, P. G.; Howie, Graham

doi:10.1111/1742-6723.12618

Cited by 20 publications

(18 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In Sweden, prehospital emergency nurses (PENs) have an important role in the assessment and triaging of dyspnoea patients at the scene. The treatment of dyspnoea begins with the management of the underlying condition, due to which the diagnosis of acute dyspnoea is crucial in EMS settings to ensure the provision of appropriate treatment and care [7]. Patients with dyspnoea constitute a complex group, as the presence of additional health problems makes it difficult to identify the underlying cause of the condition.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and outcomes of patients with dyspnoea as the main symptom, assessed by prehospital emergency nurses- a retrospective observational study

et al. 2020

View full text Add to dashboard Cite

Background: Dyspnoea (breathing difficulty) is among the most commonly cited reasons for contacting emergency medical services (EMSs). Dyspnoea is caused by several serious underlying medical conditions and, based on patients individual needs and complex illnesses or injuries, ambulance staff are independently responsible for advanced care provision. Few large-scale prehospital studies have reviewed patients with dyspnoea. This study aimed to describe the characteristics and final outcomes of patients whose main symptom was classified as dyspnoea by the prehospital emergency nurse (PEN). Methods: This retrospective observational study included patients aged > 16 years whose main symptom was dyspnoea. All the enrolled patients were assessed in the southwestern part of Sweden by PENs during January and December, 2017. Of 7260 assignments (9% of all primary missions), 6354 fulfilled the inclusion criteria. Analysis was performed using descriptive statistics, and the tests used were odds ratios and Kaplan-Meier analysis. Results: The patients mean age was 73 years, and approximately 56% were women. More than 400 different final diagnostic codes (International Statistical Classification of Diseases and Related Health Problems [ICD]-10th edition) were observed, and 11% of the ICD-10 codes denoted time-critical conditions. The three most commonly observed aetiologies were chronic obstructive pulmonary disease (20.4%), pulmonary infection (17.1%), and heart failure (15%). The comorbidity values were high, with 84.4% having previously experienced dyspnoea. The overall 30-day mortality was 11.1%. More than half called EMSs more than 50 h after symptom onset. Conclusions: Among patients assessed by PENs due to dyspnoea as the main symptom there were more than 400 different final diagnoses, of which 11% were regarded as time-critical. These patients had a severe comorbidity and 11% died within the first 30 days.

show abstract

Section: Introductionmentioning

confidence: 99%

Characteristics and outcomes of patients with dyspnoea as the main symptom, assessed by prehospital emergency nurses- a retrospective observational study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Despite the crucial nature of this work performed by paramedics, there are only a few papers covering this area [10][11][12][13][14] and the results vary widely. Cummins and co-workers have investigated the accuracy of preliminary diagnoses made by paramedics with an overall accuracy of 70% [12].…”

Section: Introductionmentioning

confidence: 99%

“…Cummins and co-workers have investigated the accuracy of preliminary diagnoses made by paramedics with an overall accuracy of 70% [12]. Two studies evaluated paramedic diagnoses in respiratory emergencies and the authors found that when paramedics determined the underlying etiology in breathing difficulties, either cardiac, respiratory or other disease, they had an agreement of 81,1% [11] and when making preliminary diagnoses they had an accuracy of 64% [10]. In an intervention study, paramedics identified sepsis using a screening tool with an accuracy of 78,2% [13] and an ST-segment elevation myocardial infarction was detected with reasonable accuracy [14,15].…”

Section: Introductionmentioning

confidence: 99%

“…In an intervention study, paramedics identified sepsis using a screening tool with an accuracy of 78,2% [13] and an ST-segment elevation myocardial infarction was detected with reasonable accuracy [14,15]. Studies show that paramedics with a longer education are better at clinical decision-making [6,10,15]. However, there are no international standards or regulations for paramedics or prehospital emergency care nurses [16] which makes it difficult to generalize the results of the studies.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The accuracy of preliminary diagnoses made by paramedics – a cross-sectional comparative study

Koivulahti

Tommila

Haavisto

2020

Scand J Trauma Resusc Emerg Med

View full text Add to dashboard Cite

Background: Clinical decision-making skills of paramedics have been emphasized because of the growing complexity of emergency medicine nursing. A preliminary diagnosis made by a paramedic has an essential role in directing the subsequent care. An accurate preliminary diagnosis improves the patient's outcome. The research in this area is relatively scarce and there are no previous studies in Finland describing the accuracy of preliminary diagnoses made by paramedics. The aim of this study was to evaluate whether paramedics are making accurate preliminary diagnoses for the patients they are transporting to hospital. In addition, the aim was to describe the variables related to an accurate preliminary diagnosis. Methods: A cross-sectional comparative approach was used and conducted through a questionnaire to gather data from the paramedics. A total of 71 paramedics participated in the study and 378 patient cases were included. The paramedics were asked to describe the basic information of a case, to state their preliminary diagnosis, and give their own educational background. The accuracy of the paramedic's preliminary diagnosis was compared with the discharge diagnosis of the ED physicians retrieved from hospital's patient records. Logistic regression analysis and a binomial test were used to test the statistical significance. Results: The agreement between the paramedics' preliminary diagnosis vs. hospital diagnosis was 70% (n = 261). Diagnostic accuracy varied according to the medical condition from mental diseases and intoxication (86%, p = 0, 000), cerebral strokes (81%, p = 0,007) to infections (31% p = 0,029). The educational background of a bachelordegree-level paramedic (p = 0,016, 95% Cl 1,7-139,6) and a good self-assessment value (p = 0,003, 95% Cl 1,2-2,7) were related to making a correct diagnosis. Conclusions: Paramedics are able to determine preliminary diagnoses at satisfactory level. The relationship between educational background and diagnostic accuracy suggests that there is a definitive need for a specific prehospital nursing education.

show abstract

“…en route to hospital [ 11 ]. The difficulties of prehospital diagnosis mean that prehospital CPAP is likely to be applied generally to all cases of acute respiratory failure, rather than directed towards those due to a specific cause [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

The ACUTE (Ambulance CPAP: Use, Treatment effect and economics) feasibility study: a pilot randomised controlled trial of prehospital CPAP for acute respiratory failure

Fuller

Goodacre

Keating

et al. 2018

Pilot Feasibility Stud

View full text Add to dashboard Cite

BackgroundAcute respiratory failure (ARF) is a common and life-threatening medical emergency. Standard prehospital management involves controlled oxygen therapy and disease-specific ancillary treatments. Continuous positive airway pressure (CPAP) is a potentially beneficial alternative treatment that could be delivered by emergency medical services. However, it is uncertain whether this treatment could work effectively in United Kingdom National Health Service (NHS) ambulance services and if it represents value for money.MethodsAn individual patient randomised controlled external pilot trial will be conducted comparing prehospital CPAP to standard oxygen therapy for ARF. Adults presenting to ambulance service clinicians will be eligible if they have respiratory distress with peripheral oxygen saturation below British Thoracic Society (BTS) target levels, despite titrated supplemental oxygen. Enrolled patients will be allocated (1:1 simple randomisation) to prehospital CPAP (O_two system) or standard oxygen therapy using identical sealed boxes. Feasibility outcomes will include incidence of recruited eligible patients, number of erroneously recruited patients and proportion of cases adhering to allocation schedule and treatment, followed up at 30 days and with complete data collection. Effectiveness outcomes will comprise survival at 30 days (definitive trial primary end point), endotracheal intubation, admission to critical care, length of hospital stay, visual analogue scale (VAS) dyspnoea score, EQ-5D-5L and health care resource use at 30 days. The cost-effectiveness of CPAP, and of conducting a definitive trial, will be evaluated by updating an existing economic model. The trial aims to recruit 120 patients over 12 months from four regional ambulance hubs within the West Midlands Ambulance Service (WMAS). This sample size will allow estimation of feasibility outcomes with a precision of < 5%. Feasibility and effectiveness outcomes will be reported descriptively for the whole trial population, and each trial arm, together with their 95% confidence intervals.DiscussionThis study will determine if it is feasible, acceptable and cost-effective to undertake a full-scale trial comparing CPAP and standard oxygen treatment, delivered by ambulance service clinicians for ARF. This will inform NHS practice and prevent inappropriate prehospital CPAP adoption on the basis of limited evidence and at a potentially substantial cost.Trial registrationISRCTN12048261. Registered on 30 August 2017. http://www.isrctn.com/ISRCTN12048261

show abstract

Accuracy of working diagnosis by paramedics for patients presenting with dyspnoea

Cited by 20 publications

References 17 publications

Characteristics and outcomes of patients with dyspnoea as the main symptom, assessed by prehospital emergency nurses- a retrospective observational study

Characteristics and outcomes of patients with dyspnoea as the main symptom, assessed by prehospital emergency nurses- a retrospective observational study

The accuracy of preliminary diagnoses made by paramedics – a cross-sectional comparative study

The ACUTE (Ambulance CPAP: Use, Treatment effect and economics) feasibility study: a pilot randomised controlled trial of prehospital CPAP for acute respiratory failure

Contact Info

Product

Resources

About