Level of agreement between prehospital and emergency department vital signs in trauma patients

Dinh, Michael; Oliver, Matthew; Bein, Kendall J; Muecke, Stephen; Carroll, Therese; Veillard, Anne-Sophie; Gabbe, Belinda; Ivers, Rebecca

doi:10.1111/1742-6723.12126

Cited by 17 publications

(14 citation statements)

References 30 publications

(33 reference statements)

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“…However, once again, the limits of agreement provide further information. Across both studies, the widest 95% limits of agreement were −12‐+10 (between Emergency Medical Services and the Emergency Department; Dinh et al., 2013), while the narrowest were −4.2‐+4.4 (for two simultaneous observers; Lim et al., 2002).…”

Section: Resultsmentioning

confidence: 96%

“…Two studies investigated inter ‐observer variability (Dinh et al., 2013; Lim et al., 2002) and/or intra ‐observer variability (Lim et al., 2002) in RR measurements (Table 3 & Table S2). Given the small number of studies and their divergent methodologies, meta‐analysis was not considered appropriate.…”

Section: Resultsmentioning

confidence: 99%

“…Dinh et al. (2013) reported a significant difference between RRs measured first by Emergency Medical Services clinicians and subsequently by Emergency Department staff. However, the mean magnitude of this difference was smaller than 1 breath/min.…”

Section: Resultsmentioning

confidence: 99%

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Quantitative systematic review: Sources of inaccuracy in manually measured adult respiratory rate data

Kallioinen

Hill

Christofidis

et al. 2020

Journal of Advanced Nursing

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Aims To identify the potential sources of inaccuracy in manually measured adult respiratory rate (RR) data and quantify their effects. Design Quantitative systematic review with meta‐analyses where appropriate. Data Sources Medline, CINAHL, and Cochrane Library (from database inception to 31 July 2019). Review Methods Studies presenting data on individual sources of inaccuracy in the manual measurement of adult RR were analysed, assessed for quality, and grouped according to the source of inaccuracy investigated. Quantitative data were extracted and synthesized and meta‐analyses performed where appropriate. Results Included studies (N = 49) identified five sources of inaccuracy. The awareness effect creates an artefactual reduction in actual RR, and observation methods involving shorter counts cause systematic underscoring. Individual RR measurements can differ substantially in either direction between observations due to inter‐ or intra‐observer variability. Value bias, where particular RRs are over‐represented (suggesting estimation), is a widespread problem. Recording omission is also widespread, with higher average rates in inpatient versus triage/admission contexts. Conclusion This review demonstrates that manually measured RR data are subject to several potential sources of inaccuracy. Impact RR is an important indicator of clinical deterioration and commonly included in track‐and‐trigger systems. However, the usefulness of RR data depends on the accuracy of the observations and documentation, which are subject to five potential sources of inaccuracy identified in this review. A single measurement may be affected by several factors. Hence, clinicians should interpret recorded RR data cautiously unless systems are in place to ensure its accuracy. For nurses, this includes counting rather than estimating RRs, employing 60‐s counts whenever possible, ensuring patients are unaware that their RR is being measured, and documenting the resulting value. For any given site, interventions to improve measurement should take into account the local organizational and cultural context, available resources, and the specific measurement issues that need to be addressed.

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Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

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Quantitative systematic review: Sources of inaccuracy in manually measured adult respiratory rate data

Kallioinen

Hill

Christofidis

et al. 2020

Journal of Advanced Nursing

View full text Add to dashboard Cite

show abstract

“…Furthermore, the patient's symptoms and signs on the arrival of the EMS often differ compared with those shown on the arrival at the emergency department [38][39][40]. This difference can be explained by prehospital treatment received or the spontaneous change in the patient's condition during transport.…”

Section: Discussionmentioning

confidence: 99%

Prehospital factors associated with an acute life-threatening condition in non-traumatic chest pain patients — A systematic review

Wibring

Herlitz

Christensson

et al. 2016

International Journal of Cardiology

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“…[5][6][7][8][9][10][11] During prehospital transport, measured BPs vary widely. In part, EMS intervention prompts the physiologic change, 12 but studies suggest that recording consecutive BP can cause discrepancies that may not correlate with real change over time. 13 Variation in BP has also been shown to occur with differing machines 14 and techniques.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Non-Invasive Blood Pressure Measurement Strategies with Intra-Arterial Measurement

Rebesco

Pinkston

Smyrnios

et al. 2020

Prehosp. Disaster med.

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Introduction: It is difficult to obtain an accurate blood pressure (BP) measurement, especially in the prehospital environment. It is not known fully how various BP measurement techniques differ from one another. Study Objective: The study hypothesized that there are differences in the accuracy of various non-invasive blood pressure (NIBP) measurement strategies as compared to the gold standard of intra-arterial (IA) measurement. Methods: The study enrolled adult intensive care unit (ICU) patients with radial IA catheters placed to measure radial intra-arterial blood pressure (RIBP) as a part of their standard care at a large, urban, tertiary-care Level I trauma center. Systolic blood pressure (SBP) was taken by three different NIBP techniques (oscillometric, auscultated, and palpated) and compared to RIBP measurements. Data were analyzed using the paired t-test with dependent samples to detect differences between RIBP measurements and each NIBP method. The primary outcome was the difference in RIBP and NIBP measurement. There was also a predetermined subgroup analysis based on gender, body mass index (BMI), primary diagnosis requiring IA line placement, and current vasoactive medication use. Results: Forty-four patients were enrolled to detect a predetermined clinically significant difference of 5mmHg in SBP. The patient population was 63.6% male and 36.4% female with an average age of 58.4 years old. The most common primary diagnoses were septic shock (47.7%), stroke (13.6%), and increased intracranial pressure (ICP; 13.6%). Most patients were receiving some form of sedation (63.4%), while 50.0% were receiving vasopressor medication and 31.8% were receiving anti-hypertensive medication. When compared to RIBP values, only the palpated SBP values had a clinically significant difference (9.88mmHg less than RIBP; P < .001). When compared to RIBP, the oscillometric and auscultated SBP readings showed statistically but not clinically significant lower values. The palpated method also showed a clinically significant lower SBP reading than the oscillometric method (5.48mmHg; P < .001) and the auscultated method (5.06mmHg; P < .001). There was no significant difference between the oscillometric and auscultated methods (0.42mmHg; P = .73). Conclusion: Overall, NIBPs significantly under-estimated RIBP measurements. Palpated BP measurements were consistently lower than RIBP, which was statistically and clinically significant. These results raise concern about the accuracy of palpated BP and its pervasive use in prehospital care. The data also suggested that auscultated and oscillometric BP may provide similar measurements.

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Level of agreement between prehospital and emergency department vital signs in trauma patients

Cited by 17 publications

References 30 publications

Quantitative systematic review: Sources of inaccuracy in manually measured adult respiratory rate data

Quantitative systematic review: Sources of inaccuracy in manually measured adult respiratory rate data

Prehospital factors associated with an acute life-threatening condition in non-traumatic chest pain patients — A systematic review

A Comparison of Non-Invasive Blood Pressure Measurement Strategies with Intra-Arterial Measurement

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