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Paramedic Diagnostic Accuracy for Patients Complaining of Chest Pain or Shortness of Breath

Published online by Cambridge University Press:  28 June 2012

Jeffrey J. Schaider ,
John C. Riccio ,
Robert J. Rydman  and
Peter T. Pons
Jeffrey J. Schaider*
Affiliation:
Senior Attending Physician, Department of Emergency Medicine, Cook County Hospital; Assistant Professor of Emergency Medicine, Chicago Medical School, Chicago, Illinois
John C. Riccio
Affiliation:
Attending Physician, Porter Memorial Hospital, Denver, Colorado
Robert J. Rydman
Affiliation:
Department of Emergency Medicine, Cook County Hospital; Associate Professor, School of Public Health, University of Illinois, Chicago, Illinois
Peter T. Pons
Affiliation:
Department of Emergency Medicine, Denver General Hospital; Associate Professor of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado
*
Department of Emergency Medicine, 1900 W. Polk St., 10th Floor, Chicago, IL 60612USA
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Abstract

Introduction:

A multitude of life-threatening and nonlife-threatening processes cause chest pain and shortness of breath. Prehospital therapy for these patients may be lifesaving and includes pharmacologic interventions, as well as invasive procedures. Appropriate therapy depends on the diagnostic skills of the paramedic.

Objective:

This study was undertaken to determine the accuracy of the paramedic diagnosis in patients transported with a chief complaint of pain or shortness of breath.

Setting:

Multihospital, one large municipal hospital, one community hospital.

Design:

Prospective, cross-sectional study. Paramedics evaluated the patient and then completed a standard form indicating the diagnosis. The paramedic's and final emergency physician's diagnoses were compared to assess the accuracy of the paramedic diagnosis.

Population:

All patients who complained of chest pain or shortness of breath, transported to the study centers by the city of Denver paramedia, were eligible for the study. Ninety-nine of the 102 patients enrolled had complete records for analysis and were entered into the study.

Results:

Diagnostic concordance data were analyzed by organ system (e.g., cardiac, pulmonary, etc.) and for specific diagnoses using the kappa statistic and McNemar's chi-square analysis for discordant pairs. Using the kappa statistic, there was statistically significant concordance between the paramedic and emergency-physician diagnosis for cardiac (p = 0.0001; kappa value = 0.54) and pulmonary organ systems (p = 0.0001; kappa value = 0.61). Overall, for organ system diagnosis, the paramedics had an 82% accuracy (p = 0.05) rating. For specific cardiac and pulmonary diagnosis, paramedics had good concordance with emergency physicians.

Conclusions:

Overall, paramedia have excellent diagnosis by organ system. They retained good agreement on specific cardiac diagnoses and pulmonary diagnosis.

Keywords

chest paindiagnosisparamedicshortness of breath
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 10 , Issue 4 , December 1995 , pp. 245 - 250
Copyright
Copyright © World Association for Disaster and Emergency Medicine 1995

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References

1. Roth, A, Barbash, GI, Hod, H, et al. : Should thrombolytic therapy be administered in the mobile intensive care unit in patients with evolving myocardial infarction? A pilot study. J Am Coll Cardiol 1990;15:932–934.CrossRefGoogle ScholarPubMed
2. Castaigne, AD, Christian, H, Duval-Moulin, AM, et al. : Prehospital use of APSAC: Results of a placebo-controlled study. Am J Cardiol 1989;64:30A–33A.CrossRefGoogle ScholarPubMed
3. Weiss, AT, Fine, DG, Applebaum, D, et al. : Prehospital coronary thrombolysis. Chest 1987;92:124–128.CrossRefGoogle ScholarPubMed
4. Kennedy, JW, Weaver, WD: Potential use of thrombolytic therapy before hospitalization. Am J Cardiol 1989;64:8A–11A.CrossRefGoogle ScholarPubMed
5. Hargarten, RM, Aprahamian, C, Stueven, H, et al. : Limitations of prehospital predictors of acute myocardial infarction and unstable angina. Ann Emerg Med 1987;16:1325–1329.CrossRefGoogle ScholarPubMed
6. Schroeder, JS, Lamb, IH, Hu, M: The prehospital course of patients with chest pain. Am J Med 1978;64:742–748.CrossRefGoogle ScholarPubMed
7. Wuerz, RC, Meador, SA: Effects of prehospital medications on mortality and length of stay in congestive heart failure. Ann Emerg Med 1992;21:669–674.CrossRefGoogle ScholarPubMed
8. Hoffman, JF, Reynolds, S: Comparison of nitroglycerin, morphine and furosemide in treatment of presumed prehospital pulmonary edema. Chest 1987;92:586–593.CrossRefGoogle ScholarPubMed
9. Tresch, DD, Dabrowski, RC, Fiorette, GP, et al. : Out-of-hospital pulmonary edema: Diagnosis and treatment. Ann Emerg Med 1983; 12:533–537.CrossRefGoogle ScholarPubMed
10. Grim, PS, Feldman, T, Childers, RW: Evaluation of patients for the need of thrombolytic therapy in the prehospital setting. Ann Emerg Med 1989;18:483–488.CrossRefGoogle ScholarPubMed
11. Grim, PS, Eeldman, T, Martin, M, et al. : Cellular-telephone transmission of 12-lead electrocardiograms from ambulance to hospital. Am J Cardiol 1987;60:715–720.CrossRefGoogle ScholarPubMed
12. Karagounis, L, Ipsen, SK, Jessop, MR, et al. : Impact of field-transmitted electrocardiography on time to in-hospital thrombolytic therapy in acute myocardial infarction. Am J Cardiol 1990;66:786–791.CrossRefGoogle ScholarPubMed