The potential of new prediction models for emergency medical dispatch prioritisation of patients with chest pain: a cohort study

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

卷:30

Kristoffer Wibring¹  Markus Lingman²  Angela Bång³  Johan Herlitz⁴ 

[1] Department of Ambulance and Prehospital Care, Region Halland;

[2] Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg;

[3] Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg;

[4] The Prehospital Research Center Western Sweden, University of Borås;

关键词: Chest pain;    Emergency medical services;    Emergency medical dispatch;    Acute coronary syndrome;    Signs and symptoms;    Risk assessment;   

DOI  :  10.1186/s13049-022-01021-5

来源: DOAJ

【 摘 要 】

Abstract Objectives To develop emergency medical dispatch (EMD) centre prediction models with high sensitivity and satisfying specificity to identify high-priority patients and patients suitable for non-emergency care respectively, when assessing patients with chest pain. Methods Observational cohort study of 2917 unselected patients with chest pain who contacted an EMD centre in Sweden due to chest pain during 2018. Multivariate logistic regression was applied to develop models predicting low-risk or high-risk condition, that is, occurrence of time-sensitive diagnosis on hospital discharge. Results Prediction models were developed for the identification of patients suitable for high- and low-priority dispatch, using 11 and 10 variables respectively. The area under the receiver-operating characteristic curve (AUROC) for the high-risk prediction model was 0.79 and for the low-risk model it was 0.74. When applying the high-risk prediction model, 56% of the EMS missions were given highest priority, compared with 65% with the current standard. When applying the low-risk model, 7% were given the lowest priority compared to 1% for the current standard. The new prediction models outperformed today’s dispatch priority accuracy in terms of sensitivity as well as positive and negative predictive value in both high- and low-risk prediction. The low-risk model predicted almost six times as many patients as having low-risk conditions compared with today’s standard. This was done without increasing the number of high-risk patients wrongly assessed as low-risk. Conclusions By introducing prediction models, based on logistic regression analyses, using variables obtained by standard EMD-questions on age, sex, medical history and symptomology, EMD prioritisation can be improved compared with using current criteria index-based ones. This will allow a more efficient emergency medical services resource allocation.

【 授权许可】

Unknown