医疗优先调度系统®在过量预防服务中识别需要胸部压缩的患者的性能:回顾性队列研究
Richard Armour1,2,3,4, Brian Grunau3,5,6,7, Sammy Iammarino8,9
1Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia.
Prehospital emergency care
|February 26, 2024
概括
医疗优先调度系统 (MPDS) 可能错误地建议在过量预防服务 (OPS) 中对过量患者进行电信心肺复苏 (T-CPR). 需要新的策略来提高这些脆弱个体的调度准确性.
科学领域:
- 紧急医疗服务 紧急医疗服务
- 公共卫生 公共卫生
- 心脏病学 心脏病学
背景情况:
- 医疗优先调度系统 (MPDS) 对于对911电话进行分类和在怀疑医院外心脏骤停 (OHCA) 时启动电信心肺复苏 (T-CPR) 是至关重要的.
- 药物中毒紧急情况可能会出现模仿OHCA的症状,这对准确的调度分类构成了挑战.
- 过量剂量预防服务 (OPS) 是一个独特的环境,有过量剂量风险的个人可以寻求帮助.
研究的目的:
- 评估MPDS在识别需要T-CPR的患者的诊断性能.
- 专门评估过量预防服务 (OPS) 设置中的MPDS性能.
- 将药物中毒紧急情况的MPDS准确度与其他紧急医疗系统 (EMS) 病例进行比较.
主要方法:
- 一项回顾性队列研究分析了2019年5月1日至2023年1月31日期间由省级EMS服务的患者.
- 对T-CPR需要的MPDS评估与EMS到达时无脉动的黄金标准进行了比较.
- 分析了绩效指标,将OPS地点与其他地点进行比较,并将药物中毒病例与其他分类进行比较.
主要成果:
- 与其他地点相比,MPDS在OPS表现出较低的特异性 (87.3%) 和积极预测值 (0.3%),分别为98.1%和35.7%,表明T-CPR.有更多的错误阳性.
- 对于药物中毒紧急情况,MPDS显示较高的灵敏度 (83.6%),但明显较低的特异性 (77.6%) 和积极的预测值 (10.5%),相比其他情况下.
- 与其他场景相比,OPS (5.24) 和药物中毒病例 (3.73) 中T-CPR的阳性概率比率与其他场景相比显著较低 (分别为32.36和57.88).
结论:
- 在OPS设置中,MPDS准确识别需要T-CPR的患者的能力有很大差异,这往往导致对非心脏骤停患者不适当的T-CPR建议.
- 药物中毒紧急情况对MPDS来说是一个独特的挑战,假阳性T-CPR指示的可能性更高.
- 与物质使用者合作制定量身定制的调度策略对于改善医院前护理和避免对过量患者进行关键干预的延迟至关重要.
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