The use of Cincinnati prehospital stroke scale during telephone dispatch interview increases the accuracy in identifying stroke and transient ischemic attack symptoms

BMC Health Services Research

Guido Francesco Villa¹  Paolo Giorgi Rossi²  Assunta De Luca³ 

[1]Pre hospital emergency Operative Center of Lecco and coordinator of Italian Group Pre-hospital management of acute stroke – Italian Society of pre hospital emergency Services (SIS118). New affiliation: Azienda Regionale Emergenza Urgenza (AREU), Milan Lombardy, Italy

[2]Servizio interaziendale di epidemiologia AUSL, Reggio Emilia, Italy

[3]Health Direction of Regional Authority of Emergency Services (ARES 118) Lazio Region Italy. New affiliation, Health Direction of Sant’Andrea Hospital Sapienza Rome University, Via Tronto 32, Roma, CAP 00198 Italy

关键词: Stroke and/or TIA symptoms;    TIA;    Stroke;    Emergency medical system;    Cincinnati Prehospital stroke scale;   

Others  :  1134477
DOI  :  10.1186/1472-6963-13-513

 received in 2013-04-07, accepted in 2013-11-29,  发布年份 2013

【 摘 要 】

Background

Timely and appropriate hospital treatment of acute cerebrovascular diseases (stroke and Transient Ischemic Attacks - TIA) improves patient outcomes. Emergency Medical Service (EMS) dispatchers who can identify cerebrovascular disease symptoms during telephone requests for emergency service also contribute to these improved outcomes. The Italian Ministry of Health issued guidelines on the management of AC patients in pre-hospital emergency service, including Cincinnati Prehospital Stroke Scale (CPSS) use.

We measured the sensitivity and Positive Predictive Value (PPV) of EMS dispatchers’ ability to recognize stroke/TIA symptoms and evaluated whether the CPSS improves accuracy.

Methods

A cross-sectional multicentre study was conducted to collect data from 38 Italian emergency operative centres on all cases identified with stroke/TIA symptoms at the time of dispatch and all cases with stroke/TIA symptoms identified on the scene by the ambulance personnel from November 2010 to May 2011.

Results

The study included 21760 cases: 18231 with stroke/TIA symptoms at dispatch and 9791 with symptoms confirmed on the scene. The PPV of the dispatch stroke/TIA symptoms identification was 34.3% (95% CI 33.7-35.0; 6262/18231) and the sensitivity was 64.0% (95% CI 63.0-64.9; 6262/9791). Centres using CPSS more often (>10% of cases) had both higher PPV (56%; CI 95% 57–60 vs 18%; CI 95% 17–19) and higher sensitivity (71%; CI 95% 87–89 vs 52%; CI 95% 51–54).

In the multivariate regression a centre’s CPSS use was associated with PPV (beta 0.48 p = 0.014) and negatively associated with sensitivity (beta -0.36; p = 0.063); centre sensitivity was associated with CPSS (beta 0.32; p = 0.002), adjusting for PPV.

Conclusions

Centres that use CPSS more frequently during phone dispatch showed greater agreement with on-the-scene prehospital assessments, both in correctly identifying more cases with stroke/TIA symptoms and in giving fewer false positives for non-stroke/TIA cases. Our study shows an extreme variability in the performance among OCs, highlighting that form many centres there is room for improvement in both sensitivity and positive predictive value of the dispatch. Our results should be used for benchmarking proposals in the effort to identify best practices across the country.

【 授权许可】

   
2013 De Luca et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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