Telephone triage and dispatch of ambulances to patients with suspected and verified acute stroke - a descriptive study
Abstract Objectives In this study we aimed to explore EMCC triage of suspected and confirmed stroke patients to gain more knowledge about the initial phase of the acute stroke response chain. Accurate dispatch at the Emergency Medical Communication Center (EMCC) is crucial for optimal resource utili...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-03-01
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| Series: | BMC Emergency Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12873-024-00962-7 |
| _version_ | 1797259433187737600 |
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| author | Bjørn Jamtli Maren Ranhoff Hov Trine Møgster Jørgensen Jo Kramer-Johansen Hege Ihle-Hansen Else Charlotte Sandset Håvard Wahl Kongsgård Camilla Hardeland |
| author_facet | Bjørn Jamtli Maren Ranhoff Hov Trine Møgster Jørgensen Jo Kramer-Johansen Hege Ihle-Hansen Else Charlotte Sandset Håvard Wahl Kongsgård Camilla Hardeland |
| author_sort | Bjørn Jamtli |
| collection | DOAJ |
| description | Abstract Objectives In this study we aimed to explore EMCC triage of suspected and confirmed stroke patients to gain more knowledge about the initial phase of the acute stroke response chain. Accurate dispatch at the Emergency Medical Communication Center (EMCC) is crucial for optimal resource utilization in the prehospital service, and early identification of acute stroke is known to improve patient outcome. Materials and methods We conducted a descriptive retrospective study based on data from the Emergency Department and EMCC records at a comprehensive stroke center in Oslo, Norway, during a six-month period (2019–2020). Patients dispatched with EMCC stroke criteria and/or discharged with a stroke diagnosis were included. We identified EMCC true positive, false positive and false negative stroke patients and estimated EMCC stroke sensitivity and positive predictive value (PPV). Furthermore, we analyzed prehospital time intervals and identified patient destinations to gain knowledge on ambulance services assessments. Results We included 1298 patients. EMCC stroke sensitivity was 77% (95% CI: 72 − 82%), and PPV was 16% (95% CI: 14 − 18%). EMCC false negative stroke patients experienced an increased median prehospital delay of 11 min (p < 0.001). Upon arrival at the scene, 68% of the EMCC false negative patients were identified as suspected stroke cases by the ambulance services. Similarly, 68% of the false positive stroke patients were either referred to a GP, out-of-hours GP acute clinic, local hospitals or left at the scene by the ambulance services, indicating that no obvious stroke symptoms were identified by ambulance personnel upon arrival at the scene. Conclusions This study reveals a high EMCC stroke sensitivity and an extensive number of false positive stroke dispatches. By comparing the assessments made by both the EMCC and the ambulance service, we have identified specific patient groups that should be the focus for future research efforts aimed at improving the sensitivity and specificity of stroke recognition in the EMCC. |
| first_indexed | 2024-04-24T23:09:21Z |
| format | Article |
| id | doaj.art-7e0d9507a5d748d9bf65904291f67195 |
| institution | Directory Open Access Journal |
| issn | 1471-227X |
| language | English |
| last_indexed | 2024-04-24T23:09:21Z |
| publishDate | 2024-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Emergency Medicine |
| spelling | doaj.art-7e0d9507a5d748d9bf65904291f671952024-03-17T12:17:41ZengBMCBMC Emergency Medicine1471-227X2024-03-0124111210.1186/s12873-024-00962-7Telephone triage and dispatch of ambulances to patients with suspected and verified acute stroke - a descriptive studyBjørn Jamtli0Maren Ranhoff Hov1Trine Møgster Jørgensen2Jo Kramer-Johansen3Hege Ihle-Hansen4Else Charlotte Sandset5Håvard Wahl Kongsgård6Camilla Hardeland7Faculty of Health Sciences, Oslo Metropolitan UniversityFaculty of Health Sciences, Oslo Metropolitan UniversityFaculty of Health Sciences, Department for Prehospital Emergency Medicine, Oslo Metropolitan UniversityAir Ambulance department, Oslo University HospitalDepartment of Neurology, Oslo University HospitalDepartment of Neurology, Oslo University HospitalNorwegian Directorate of Health, Norwegian Patient RegistryFaculty of Health and Welfare, Østfold University CollegeAbstract Objectives In this study we aimed to explore EMCC triage of suspected and confirmed stroke patients to gain more knowledge about the initial phase of the acute stroke response chain. Accurate dispatch at the Emergency Medical Communication Center (EMCC) is crucial for optimal resource utilization in the prehospital service, and early identification of acute stroke is known to improve patient outcome. Materials and methods We conducted a descriptive retrospective study based on data from the Emergency Department and EMCC records at a comprehensive stroke center in Oslo, Norway, during a six-month period (2019–2020). Patients dispatched with EMCC stroke criteria and/or discharged with a stroke diagnosis were included. We identified EMCC true positive, false positive and false negative stroke patients and estimated EMCC stroke sensitivity and positive predictive value (PPV). Furthermore, we analyzed prehospital time intervals and identified patient destinations to gain knowledge on ambulance services assessments. Results We included 1298 patients. EMCC stroke sensitivity was 77% (95% CI: 72 − 82%), and PPV was 16% (95% CI: 14 − 18%). EMCC false negative stroke patients experienced an increased median prehospital delay of 11 min (p < 0.001). Upon arrival at the scene, 68% of the EMCC false negative patients were identified as suspected stroke cases by the ambulance services. Similarly, 68% of the false positive stroke patients were either referred to a GP, out-of-hours GP acute clinic, local hospitals or left at the scene by the ambulance services, indicating that no obvious stroke symptoms were identified by ambulance personnel upon arrival at the scene. Conclusions This study reveals a high EMCC stroke sensitivity and an extensive number of false positive stroke dispatches. By comparing the assessments made by both the EMCC and the ambulance service, we have identified specific patient groups that should be the focus for future research efforts aimed at improving the sensitivity and specificity of stroke recognition in the EMCC.https://doi.org/10.1186/s12873-024-00962-7Prehospital careEmergency medical servicesEmergency callsEmergency medical dispatchEmergency medical communication centerPrehospital stroke management |
| spellingShingle | Bjørn Jamtli Maren Ranhoff Hov Trine Møgster Jørgensen Jo Kramer-Johansen Hege Ihle-Hansen Else Charlotte Sandset Håvard Wahl Kongsgård Camilla Hardeland Telephone triage and dispatch of ambulances to patients with suspected and verified acute stroke - a descriptive study BMC Emergency Medicine Prehospital care Emergency medical services Emergency calls Emergency medical dispatch Emergency medical communication center Prehospital stroke management |
| title | Telephone triage and dispatch of ambulances to patients with suspected and verified acute stroke - a descriptive study |
| title_full | Telephone triage and dispatch of ambulances to patients with suspected and verified acute stroke - a descriptive study |
| title_fullStr | Telephone triage and dispatch of ambulances to patients with suspected and verified acute stroke - a descriptive study |
| title_full_unstemmed | Telephone triage and dispatch of ambulances to patients with suspected and verified acute stroke - a descriptive study |
| title_short | Telephone triage and dispatch of ambulances to patients with suspected and verified acute stroke - a descriptive study |
| title_sort | telephone triage and dispatch of ambulances to patients with suspected and verified acute stroke a descriptive study |
| topic | Prehospital care Emergency medical services Emergency calls Emergency medical dispatch Emergency medical communication center Prehospital stroke management |
| url | https://doi.org/10.1186/s12873-024-00962-7 |
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