Dispatcher recognition of stroke using the national academy medical priority dispatch system

Brian H. Buck, Sidney Starkman, Marc Eckstein, Chelsea S. Kidwell, Jill Haines, Rainy Huang, Daniel Colby, Jeffrey L. Saver

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE-: Emergency medical dispatchers play an important role in optimizing stroke care if they are able to accurately identify calls regarding acute cerebrovascular disease. This study was undertaken to assess the diagnostic accuracy of the current national protocol guiding dispatcher questioning of 911 callers to identify stroke (QA Guide version 11.1 of the National Academy Medical Priority Dispatch System). METHODS-: We identified all Los Angeles Fire Department paramedic transports of patients to University of California Los Angeles Medical Center during the 12-month period from January to December 2005 in a prospectively maintained database. Dispatcher-assigned Medical Priority Dispatch System codes for each of these patient transports were abstracted from the paramedic run sheets and compared to final hospital discharge diagnosis. RESULTS-: Among 3474 transported patients, 96 (2.8%) had a final diagnosis of stroke or transient ischemic attack. Dispatchers assigned a code of potential stroke to 44.8% of patients with a final discharge diagnosis of stroke or TIA. Dispatcher identification of stroke showed a sensitivity of 0.41, specificity of 0.96, positive predictive value of 0.45, and negative predictive value of 0.95. CONCLUSIONS-: Dispatcher recognition of stroke calls using the widely employed Medical Priority Dispatch System algorithm is suboptimal, with failure to identify more than half of stroke patients as likely stroke. Revisions to the current national dispatcher structured interview and symptom identification algorithm for stroke may facilitate more accurate recognition of stroke by emergency medical dispatchers.

Original languageEnglish (US)
Pages (from-to)2027-2030
Number of pages4
JournalStroke
Volume40
Issue number6
DOIs
StatePublished - Jun 1 2009

Fingerprint

Stroke
Allied Health Personnel
Los Angeles
Cerebrovascular Disorders
Transient Ischemic Attack
Acute Disease
Databases
Interviews
Sensitivity and Specificity

Keywords

  • Emergency medical services
  • Prehospital care
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Buck, B. H., Starkman, S., Eckstein, M., Kidwell, C. S., Haines, J., Huang, R., ... Saver, J. L. (2009). Dispatcher recognition of stroke using the national academy medical priority dispatch system. Stroke, 40(6), 2027-2030. https://doi.org/10.1161/STROKEAHA.108.545574

Dispatcher recognition of stroke using the national academy medical priority dispatch system. / Buck, Brian H.; Starkman, Sidney; Eckstein, Marc; Kidwell, Chelsea S.; Haines, Jill; Huang, Rainy; Colby, Daniel; Saver, Jeffrey L.

In: Stroke, Vol. 40, No. 6, 01.06.2009, p. 2027-2030.

Research output: Contribution to journalArticle

Buck, BH, Starkman, S, Eckstein, M, Kidwell, CS, Haines, J, Huang, R, Colby, D & Saver, JL 2009, 'Dispatcher recognition of stroke using the national academy medical priority dispatch system', Stroke, vol. 40, no. 6, pp. 2027-2030. https://doi.org/10.1161/STROKEAHA.108.545574
Buck BH, Starkman S, Eckstein M, Kidwell CS, Haines J, Huang R et al. Dispatcher recognition of stroke using the national academy medical priority dispatch system. Stroke. 2009 Jun 1;40(6):2027-2030. https://doi.org/10.1161/STROKEAHA.108.545574
Buck, Brian H. ; Starkman, Sidney ; Eckstein, Marc ; Kidwell, Chelsea S. ; Haines, Jill ; Huang, Rainy ; Colby, Daniel ; Saver, Jeffrey L. / Dispatcher recognition of stroke using the national academy medical priority dispatch system. In: Stroke. 2009 ; Vol. 40, No. 6. pp. 2027-2030.
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AB - BACKGROUND AND PURPOSE-: Emergency medical dispatchers play an important role in optimizing stroke care if they are able to accurately identify calls regarding acute cerebrovascular disease. This study was undertaken to assess the diagnostic accuracy of the current national protocol guiding dispatcher questioning of 911 callers to identify stroke (QA Guide version 11.1 of the National Academy Medical Priority Dispatch System). METHODS-: We identified all Los Angeles Fire Department paramedic transports of patients to University of California Los Angeles Medical Center during the 12-month period from January to December 2005 in a prospectively maintained database. Dispatcher-assigned Medical Priority Dispatch System codes for each of these patient transports were abstracted from the paramedic run sheets and compared to final hospital discharge diagnosis. RESULTS-: Among 3474 transported patients, 96 (2.8%) had a final diagnosis of stroke or transient ischemic attack. Dispatchers assigned a code of potential stroke to 44.8% of patients with a final discharge diagnosis of stroke or TIA. Dispatcher identification of stroke showed a sensitivity of 0.41, specificity of 0.96, positive predictive value of 0.45, and negative predictive value of 0.95. CONCLUSIONS-: Dispatcher recognition of stroke calls using the widely employed Medical Priority Dispatch System algorithm is suboptimal, with failure to identify more than half of stroke patients as likely stroke. Revisions to the current national dispatcher structured interview and symptom identification algorithm for stroke may facilitate more accurate recognition of stroke by emergency medical dispatchers.

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