Systematic review and meta-analysis of pre-hospital diagnostic accuracy studies

Wilson, Caitlin; Harley, Clare; Steels, Stephanie

doi:10.1136/emermed-2018-207588

Cited by 15 publications

(12 citation statements)

References 35 publications

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“…Similar to findings in the review by Wilson et al 38 , this study found higher specificity than sensitivity, i.e. prehospital clinicians were better at excluding HVS than they were at recognising HVS.…”

Section: Limitationssupporting

confidence: 88%

“…The sensitivity 88% (95% CI 82-92%) and specificity 99% (95% CI 99-99%) of pre-hospital clinicians' diagnosis of HVS were slightly higher than the pooled estimate obtained in a metaanalysis on pre-hospital diagnostic accuracy by Wilson et al 38 . This means that pre-hospital clinicians were better at correctly identifying patients with HVS and without HVS on average than conditions studied in other pre-hospital diagnostic accuracy studies.…”

Section: Limitationscontrasting

confidence: 58%

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How accurate is the prehospital diagnosis of hyperventilation syndrome?

Wilson

Harley

Steels

2020

Journal of Paramedic Practice

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Background: The literature suggests that hyperventilation syndrome (HVS) should be diagnosed and treated prehospitally. Aim: To determine diagnostic accuracy of HVS by paramedics and emergency medical technicians using hospital doctors' diagnosis as the reference standard. Methods: A retrospective audit was carried out of routine data using linked prehospital and in-hospital patient records of adult patients (≥18 years) transported via emergency ambulance to two emergency departments in the UK from 1 January 2012–31 December 2013. Accuracy was measured using sensitivity, specificity, positive and negative predictive values (NPV/PPVs) and likelihood ratios (LRs) with 95% confidence intervals. Results: A total of 19 386 records were included in the analysis. Prehospital clinicians had a sensitivity of 88% (95% CI [82–92%]) and a specificity of 99% (95% CI [99–99%]) for diagnosing HVS, with PPV 0.42 (0.37, 0.47), NPV 1.00 (1.00, 1.00), LR+ 75.2 (65.3, 86.5) and LR− 0.12 (0.08, 0.18). Conclusions: Paramedics and emergency medical technicians are able to diagnose HVS prehospitally with almost perfect specificity and good sensitivity.

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Section: Limitationssupporting

confidence: 88%

Section: Limitationscontrasting

confidence: 58%

How accurate is the prehospital diagnosis of hyperventilation syndrome?

Wilson

Harley

Steels

2020

Journal of Paramedic Practice

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“…EMS providers rely on their personal skills and the automated machine annotations in their interpretation of the PH-ECG. However, previous studies have shown that EMS providers tend to have lower sensitivity (0.63 to 0.95) and specificity (0.72 to 0.94), 9 and automated ECG interpretation algorithms tend to have lower sensitivity. 10 Although systematic over-reading of PH-ECGs by a medical command physician could overcome these shortcomings, 11 it has not been widely implemented by EMS systems because of excessive cost and the lack of around-the-clock access to specialized physicians.…”

mentioning

confidence: 90%

Lack of Significant Coronary History and ECG Misinterpretation Are the Strongest Predictors of Undertriage in Prehospital Chest Pain

Faramand¹,

Frisch²,

DeSantis³

et al. 2019

Journal of Emergency Nursing

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Introduction: Appropriate prehospital (PH) triage of patients with chest pain can significantly improve outcomes in acute myocardial infarction (MI). We sought to explore how PH providers triage chest pain as high versus low risk and to evaluate the accuracy and predictors of their triage decision. Methods: This was a prospective, observational cohort study that enrolled consecutive patients with chest pain transported by emergency medical services (EMS) to 3 tertiary care hospitals in the US. EMS triage decision (high risk versus low-risk) was defined based on the transmission of PH electrocardiogram (ECG) to a command center for medical consultation with or without catheter laboratory activation. Two independent reviewers examined in-hospital medical records to adjudicate the presence of acute MI and to audit the findings on the presenting ECG. Results: We enrolled 2,065 patients (aged 56 ± 17, 53% male) of whom 768 (37%) were triaged as high risk. Those triaged as high risk were older, were more likely to be men or have significant cardiac history, and had a higher rate of acute MI events(14.2% versus 3.5%). The sensitivity and specificity for triaging MI events as high risk were 70% and 97%, respectively. A total of 46/155 (30%) MI events were misclassified as low risk. No previous coronary revascularization and ECG misinterpretation were strong independent predictors of such undertriage. Conclusions: PH providers have moderate sensitivity in triaging high-risk patients; 1 in 3 MI events are undertriaged. Emergency nurses need to pay special attention to patients with benign past histories during transition of care and should always reinterpret ECGs for subtle ischemic changes.

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“…Most modern emergency systems are based on paramedics. They are considered sufficiently sensitive and specific in identifying patients with life threatening conditions, but there is a notable heterogeneity between studies and a wide range of estimates [14]. In the past, all ambulances in Poland used to have a physician on board.…”

Section: Discussionmentioning

confidence: 99%

Reliability of prehospital diagnosis of acute cerebrovascular accident

Karliñski

Kozera-Strzelińska

Sienkiewicz-Jarosz

et al. 2022

Neurol Neurochir Pol.

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Introduction.Early and correct suspicion of an acute cerebrovascular accident (CVA) is necessary to minimise the time to reperfusion treatment. Our aim was to evaluate the reliability of a prehospital diagnosis of stroke or transient ischaemic attack made by healthcare professionals referring patients directly to a neurological Emergency Department (ED).Material and methods. This retrospective analysis included all consecutive patients referred between 1 January and 31 December 2014 by ambulance physicians, paramedics or outpatient physicians to the neurological ED providing care for the 300-350,000 inhabitants of a highly urbanised area. We calculated sensitivity and positive predictive value (PPV) with 95% confidence intervals (95% CI) for each group of healthcare professionals, and compared the proportions of undetected CVAs. Results.Of 802 patients referred with a prehospital diagnosis of CVA, 544 were confirmed. Additional 95 CVA cases were referred with a diagnosis other than CVA. The highest sensitivity for detection of any CVA was among ambulance physicians (96%; 95% CI 92-98%), followed by paramedics (85%; 95% CI 80-90%; p < 0.001) and outpatient physicians (74%; 95% CI 70-79%; p < 0.001). PPV for stroke was 83% (95% CI 77-87%) among ambulance physicians, 73% (95% CI 65-80%) among paramedics, and 56% (95% CI 47-64%) among outpatient physicians.Conclusions. Ambulance physicians are highly sensitive in diagnosing any CVA, and are correct in 8 out of 10 cases. The inferior performance of paramedics and outpatient physicians indicates the need for regular stroke training for paramedics and the implementation of two-way communication with the stroke team to identify potential candidates for reperfusion therapy before arrival at the ED.

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Systematic review and meta-analysis of pre-hospital diagnostic accuracy studies

Abstract: CRD42016039306.

Cited by 15 publications

References 35 publications

How accurate is the prehospital diagnosis of hyperventilation syndrome?

How accurate is the prehospital diagnosis of hyperventilation syndrome?

Lack of Significant Coronary History and ECG Misinterpretation Are the Strongest Predictors of Undertriage in Prehospital Chest Pain

Reliability of prehospital diagnosis of acute cerebrovascular accident

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