IngentaConnect Accuracy in identifying patients with loss of consciousness in a ...

Abstract:

Background:

The first link in the `chain of survival' is the activation of Emergency Medical Services (EMS). In the major part of Denmark, police officers operate the alarm 1-1-2 centre, including calls for EMS. Our aim was to study the police 1-1-2 operators' accuracy in identifying calls concerning patients with loss of consciousness as a key symptom of life-threatening conditions. `Unconsciousness' was defined as patients with a Glasgow Coma Scale (GCS) score of < 9, scored by the on-scene anaesthesiologist from the Mobile Emergency Care Unit (MECU). Methods:

This study was an observational cohort study based on data from the Police 1-1-2 Database and the Aarhus County Pre-hospital Database containing data from MECU cases during 6 months in 2004-05. Results:

Two thousand, three hundred and forty-three emergency calls with MECU dispatch were identified. In 1655 cases, both 1-1-2 data and the GCS score were recorded. Two hundred and ninety-five patients were found with a GCS score of < 9 at MECU arrival, 243 of whom were reported `unconscious' by 1-1-2, giving a sensitivity of 82%. One thousand, three hundred and sixty patients were found with a GCS score of ≥ 9, 972 of whom were reported `awake', giving a specificity of 72%. The positive predictive value (percentage of patients found with a GCS score of < 9 at MECU arrival amongst patients reported as `unconscious') was 39%. Conclusions:

The accuracy was moderate with room for improvement. The positive predictive value was low, indicating over-triage of MECU.

Keywords: emergency call centre; emergency medical services; medical dispatch; over-triage; pre-hospital life support; unconsciousness

Document Type: Research article

DOI: 10.1111/j.1399-6576.2007.01310.x

Affiliations: 1: Aarhus University Hospital, Department of Anaesthesia and Intensive Care Medicine, Aarhus Traumacentre, Aarhus, Denmark

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Accuracy in identifying patients with loss of consciousness in a police-operated emergency call centre - first step in the chain of survival