scholarly journals Emergency physician’s dispatch by a paramedic-staffed emergency medical communication centre: sensitivity, specificity and search for a reference standard

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Victor Nathan Chappuis ◽  
Hélène Deham ◽  
Philippe Cottet ◽  
Birgit Andrea Gartner ◽  
François Pierre Sarasin ◽  
...  
Keyword(s):  
Reference Standard ◽  
Medical Systems ◽  
Operating Characteristics ◽  
First Line ◽  
Emergency Calls ◽  
Emergency Medical ◽  
Dispatch Centre ◽  
Second Tier ◽  
Low Sensitivity ◽  
Level Of Risk

Abstract Background Some emergency medical systems (EMS) use a dispatch centre where nurses or paramedics assess emergency calls and dispatch ambulances. Paramedics may also provide the first tier of care “in the field”, with the second tier being an Emergency Physician (EP). In these systems, the appropriateness of the decision to dispatch an EP to the first line at the same time as the ambulance has not often been measured. The main objective of this study was to compare dispatching an EP as part of the first line emergency service with the severity of the patient’s condition. The secondary objective was to highlight the need for a recognized reference standard to compare performance analyses across EMS. Methods This prospective observational study included all emergency calls received in Geneva’s dispatch centre between January 1st, 2016 and June 30th, 2019. Emergency medical dispatchers (EMD) assigned a level of risk to patients at the time of the initial call. Only the highest level of risk led to the dispatch of an EP. The severity of the patient’s condition observed in the field was measured using the National Advisory Committee for Aeronautics (NACA) scale. Two reference standards were proposed by dichotomizing the NACA scale. The first compared NACA≥4 with other conditions and the second compared NACA≥5 with other conditions. The level of risk identified during the initial call was then compared to the dichotomized NACA scales. Results 97′861 assessments were included. Overall prevalence of sending an EP as first line was 13.11, 95% CI [12.90–13.32], and second line was 2.94, 95% CI [2.84–3.05]. Including NACA≥4, prevalence was 21.41, 95% CI [21.15–21.67], sensitivity was 36.2, 95% CI [35.5–36.9] and specificity 93.2 95% CI [93–93.4]. The Area Under the Receiver-Operating Characteristics curve (AUROC) of 0.7507, 95% CI [0.74734–0.75397] was acceptable. Looking NACA≥5, prevalence was 3.09, 95% CI [2.98–3.20], sensitivity was 64.4, 95% CI [62.7–66.1] and specificity 88.5, 95% CI [88.3–88.7]. We found an excellent AUROC of 0.8229, 95% CI [0.81623–0.82950]. Conclusion The assessment by Geneva’s EMD has good specificity but low sensitivity for sending EPs. The dichotomy between immediate life-threatening and other emergencies could be a valid reference standard for future studies to measure the EP’s dispatching performance.

scholarly journals Symptom-Based Dispatching in an Emergency Medical Communication Centre: Sensitivity, Specificity, and the Area under the ROC Curve

2020 ◽  
Vol 17 (21) ◽  
pp. 8254
Author(s):  
Robert Larribau ◽  
Victor Nathan Chappuis ◽  
Philippe Cottet ◽  
Simon Regard ◽  
Hélène Deham ◽  
...  
Keyword(s):  
Performance Measurement ◽  
Roc Curve ◽  
Test Performance ◽  
Reference Standard ◽  
Emergency Medical Dispatch ◽  
Medical Communication ◽  
Emergency Calls ◽  
Emergency Medical ◽  
Dispatch System ◽  
Specific Assessment

Background: Measuring the performance of emergency medical dispatch tools used in paramedic-staffed emergency medical communication centres (EMCCs) is rarely performed. The objectives of our study were, therefore, to measure the performance and accuracy of Geneva’s dispatch system based on symptom assessment, in particular, the performance of ambulance dispatching with lights and sirens (L&S) and to measure the effect of adding specific protocols for each symptom. Methods: We performed a prospective observational study including all emergency calls received at Geneva’s EMCC (Switzerland) from 1 January 2014 to 1 July 2019. The risk levels selected during the emergency calls were compared to a reference standard, based on the National Advisory Committee for Aeronautics (NACA) scale, dichotomized to severe patient condition (NACA ≥ 4) or stable patient condition (NACA < 4) in the field. The symptom-based dispatch performance was assessed using a receiver operating characteristic (ROC) curve. Contingency tables and a Fagan nomogram were used to measure the performance of the dispatch with or without L&S. Measurements were carried out by symptom, and a group of symptoms with specific protocols was compared to a group without specific protocols. Results: We found an acceptable area under the ROC curve of 0.7474, 95%CI (0.7448–0.7503) for the 148,979 assessments included in the study. Where the severity prevalence was 21%, 95%CI (20.8–21.2). The sensitivity of the L&S dispatch was 87.5%, 95%CI (87.1–87.8); and the specificity was 47.3%, 95%CI (47.0–47.6). When symptom-specific assessment protocols were used, the accuracy of the assessments was slightly improved. Conclusions: Performance measurement of Geneva’s symptom-based dispatch system using standard diagnostic test performance measurement tools was possible. The performance was found to be comparable to other emergency medical dispatch systems using the same reference standard. However, the implementation of specific assessment protocols for each symptom may improve the accuracy of symptom-based dispatch systems.

Diagnostic performance of computed tomography and diffusion-weighted imaging as first-line imaging modality according to the International Myeloma Working Group (IMWG) imaging algorithm for monoclonal plasma cell disorders

2021 ◽  
pp. 028418512110083
Author(s):  
Min A Yoon ◽  
Choong Guen Chee ◽  
Hye Won Chung ◽  
Dong Hyun Lee ◽  
Kyung Won Kim
Keyword(s):  
Plasma Cell ◽  
Diffusion Weighted Imaging ◽  
Diagnostic Performance ◽  
Imaging Modality ◽  
Reference Standard ◽  
First Line ◽  
Plasma Cell Disorders ◽  
Misclassification Rates ◽  
Line Imaging ◽  
And Diffusion

Background The latest International Myeloma Working Group (IMWG) guideline recommends low-dose whole-body (WB) computed tomography (CT) as the first-line imaging technique for the initial diagnosis of plasma cell disorders. Purpose To evaluate diagnostic performances of CT and diffusion-weighted imaging (DWI) as the first-line imaging modalities and assess misclassification rates obtained following the guideline. Material and Methods Two independent radiologists analyzed CT (acquired as PET/CT) and DWI (3-T; b-values = 50 and 900 s/mm2) of patients newly diagnosed with plasma cell disorder, categorizing the number of bone lesions. Diagnostic performance of CT and DWI was compared using the McNemar test, and misclassification rates were calculated with a consensus WB-MRI reading as the reference standard. Differences in lesion number categories were assessed using marginal homogeneity and kappa statistics. Results Of 56 patients (36 men; mean age = 63.5 years), 39 had myeloma lesions. DWI showed slightly higher sensitivity for detecting myeloma lesions (97.4%) than CT (84.6%–92.3%; P > 0.05). CT showed significantly higher specificity (88.2%) than DWI (52.9%–58.8%; P<0.05). CT had a higher additional study requirement rate than DWI (7.7%–15.4% vs. 2.6%), but a lower unnecessary treatment rate (11.8% vs. 41.2%–47.1%). Both readers showed significant differences in categorization of the number of lesions on CT compared with the reference standard ( P < 0.001), and one reader showed a significant difference on DWI ( P = 0.006 and 0.098). Conclusion CT interpreted according to the IMWG guideline is a diagnostically effective first-line modality with relatively high sensitivity and specificity. DWI alone may not be an acceptable first-line imaging modality because of low specificity.

A Call to Action: The Institute of Medicine Report on Emergency Medical Services for Children

PEDIATRICS ◽  
1995 ◽  
Vol 96 (1) ◽  
pp. 173-174
Author(s):  
Jane F. Knapp
Keyword(s):  
Emergency Medical Services ◽  
Pediatric Emergency ◽  
Medical Services ◽  
Institute Of Medicine ◽  
Medical Systems ◽  
Call To Action ◽  
Emergency Medical ◽  
Grant Program ◽  
Public Responsibility ◽  
Emergency Medical Systems

Emergency Medical Services for Chi (EMS-C) must be recognized as a public responsibility; the "market" cannot be relied on to produce the kind of planning and cooperation required to make services available to all who need them.1 The Institute of Medicine (IOM) Report on Emergency Medical Services For Children. Each year millions of American chi become seriously ill or injured. If you have ever encountered a child who did not receive the medical care they needed or deserved under these circumstances you understand what EMS-C is all about. The familiar adage, "Children are not small adults," emphasizes that their care must be an integral part of a system not an afterthought once the adults have been addressed. The achievement of the desired level of competence for EMS-C in the larger system is hampered by many factors. These include lack of organization, equipment, training, and a tack of understanding of the child's unique problems and needs. In response to these needs, Congress approved a demonstration grant program in 1984. The purpose of the program was threefold: to expand access to EMS-C, to improve the quality available through existing Emergency Medical Systems (EMS), and to generate knowledge and experience that would be of use to all states and localities seeking to improve their system. Continuing interest prompted the formation of the Committee on Pediatric Emergency Medical Services by the IOM. This 19-member committee Chaired by Dr Donald N. Medearis, Jr released their report in the summer of 1993. The IOM report entitled Emergency Medical Services for Chi is available in both a soft cover 25-page summary and the full text (see Appendix).

scholarly journals Dermo-Hipodermites Bacterianas Agudas Não Necrotizantes: Erisipela e Celulite Infeciosa

2021 ◽  
Vol 34 (3) ◽  
pp. 217
Author(s):  
Maria Alexandra Rodrigues ◽  
Mónica Caetano ◽  
Isabel Amorim ◽  
Manuela Selores
Keyword(s):  
Risk Factors ◽  
Necrotizing Fasciitis ◽  
Lower Limbs ◽  
First Line ◽  
Correct Treatment ◽  
Vein Thrombosis ◽  
Group A ◽  
Low Sensitivity ◽  
Atypical Presentations ◽  
Main Complication

Non-necrotizing acute dermo-hypodermal infections are infectious processes that include erysipela and infectious cellulitis, and are mainly caused by group A β-haemolytic streptococcus. The lower limbs are affected in more than 80% of cases and the risk factors are disruption of cutaneous barrier, lymphoedema and obesity. Diagnosis is clinical and in a typical setting we observe an acute inflammatory plaque with fever, lymphangitis, adenopathy and leucocytosis. Bacteriology is usually not helpful because of low sensitivity or delayed positivity. In case of atypical presentations, erysipela must be distinguished from necrotizing fasciitis and acute vein thrombosis. Flucloxacillin and cefradine remain the first line of treatment. Recurrence is the main complication, so correct treatment of the risk factors is crucial.

scholarly journals Clinical Predictors of Mortality in Prehospital Distress Calls by Emergency Medical Service Subscribers

2021 ◽  
Vol 10 (22) ◽  
pp. 5355
Author(s):  
Gabby Elbaz-Greener ◽  
Shemy Carasso ◽  
Elad Maor ◽  
Lior Gallimidi ◽  
Merav Yarkoni ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Population Based ◽  
Hospital Data ◽  
Clinical Predictors ◽  
Emergency Calls ◽  
Emergency Medical ◽  
Risk Patients ◽  
Early Decision ◽  
Risk Predictors

(1) Introduction: Most studies rely on in-hospital data to predict cardiovascular risk and do not include prehospital information that is substantially important for early decision making. The aim of the study was to define clinical parameters in the prehospital setting, which may affect clinical outcomes. (2) Methods: In this population-based study, we performed a retrospective analysis of emergency calls that were made by patients to the largest private emergency medical services (EMS) in Israel, SHL Telemedicine Ltd., who were treated on-site by the EMS team. Demographics, clinical characteristics, and clinical outcomes were analyzed. Mortality was evaluated at three time points: 1, 3, and 12 months’ follow-up. The first EMS prehospital measurements of the systolic blood pressure (SBP) were recorded and analyzed. Logistic regression analyses were performed. (3) Results: A total of 64,320 emergency calls were included with a follow-up of 12 months post index EMS call. Fifty-five percent of patients were men and the mean age was 70.2 ± 13.1 years. During follow-up of 12 months, 7.6% of patients died. Age above 80 years (OR 3.34; 95% CI 3.03–3.69, p < 0.005), first EMS SBP ≤ 130 mm Hg (OR 2.61; 95% CI 2.36–2.88, p < 0.005), dyspnea at presentation (OR 2.55; 95% CI 2.29–2.83, p < 0001), and chest pain with ischemic ECG changes (OR 1.95; 95% CI 1.71–2.23, p < 0.001) were the highest predictors of 1 month mortality and remained so for mortality at 3 and 12 months. In contrast, history of hypertension and first EMS prehospital SBP ≥ 160 mm Hg were significantly associated with decreased mortality at 1, 3 and 12 months. (4) Conclusions: We identified risk predictors for all-cause mortality in a large cohort of patients during prehospital EMS calls. Age over 80 years, first EMS-documented prehospital SBP < 130 mm Hg, and dyspnea at presentation were the most profound risk predictors for short- and long-term mortality. The current study demonstrates that in prehospital EMS call settings, several parameters can be used to improve prioritization and management of high-risk patients.

scholarly journals Classification of RA Into Active or Inactive With a Modified DAS, for Future Use as a Treat-to-target Tool, With a HandScan Score Replacing Joint Counts

2021 ◽  
Author(s):  
Maxime Verhoeven ◽  
Anton Westgeest ◽  
Janneke Tekstra ◽  
Jacob van Laar ◽  
Floris Lafeber ◽  
...  
Keyword(s):  
Medical Records ◽  
Roc Curves ◽  
Predictor Variables ◽  
Treat To Target ◽  
Reference Standard ◽  
Clinical Classification ◽  
Operating Characteristics ◽  
Clinical Interpretation ◽  
Activity Measures

Abstract ObjectivesTo establish the value of a modified DAS (DAS-OST) without joint counts but with a HandScan score (OST), versus that of DAS28, to classify RA as active versus inactive, with as reference standard the rheumatologist's clinical classification.MethodsRA patients with at least one HandScan and DAS28 measurement performed at the same visit were included. Data was extracted from medical records, as was the clinical interpretation as active or inactive RA by the rheumatologist. Logistic regression analyses were performed to calculate areas under the receiver operating characteristics (AU-ROC) curves. The clinical interpretation was used as reference standard in all analyses, and disease activity measures were used as predictor variables. The performance of predictor variables (AU-ROCs) was compared.ResultsData of 1505 unique RA patients were used for analyses. The highest AU-ROC of 0.88 (95%CI 0.85 – 0.90) was shown for DAS28; AU-ROC of DAS-OST was 0.78 (95%CI 0.75 – 0.81), difference 0.10, p<0.01.ConclusionsCompared to DAS28, DAS-OST classified RA statistically significantly less well as active versus inactive, when using the clinical classification as reference standard. However, a DAS-modification without joint scores might have a place in strategies limiting routine outpatients’ visits to the rheumatologist.

scholarly journals A study of the sensitivity and specificity of the Magnetic Resonance Imaging (MRI) technique used in the diagnosis of endometriosis versus the intraoperative appearance considered the reference standard in the diagnosis of endometriosis

2021 ◽  
Vol 28 (1) ◽  
pp. 55-61
Author(s):  
Alexandra RADU ◽  
◽  
Elvira BRATILA ◽  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Sensitivity And Specificity ◽  
Reference Standard ◽  
Resonance Imaging ◽  
First Line ◽  
Magnetic Resonance Imaging Mri ◽  
Asymptomatic Women ◽  
Bladder Invasion

Endometriosis is a gynecological pathology with chronic symptoms, which negatively affects the patient’s quality of life. The prevalence of endometriosis in asymptomatic women is between 2% and 50%, depending on the populations studied and the method of diagnosis. The severity of the symptoms as well as the probability of diagnosing endometriosis increases with age9. Because endometriosis is a gynecological condition with a nonspecific clinical picture, sometimes even asymptomatic, imaging technology can be considered the first line of diagnosis for this pathology. The main objective of this study is to evaluate the sensitivity and specificity of nuclear magnetic resonance imaging (MRI) used in the diagnosis of endometriotic lesions depending on their location, and compare the results obtained with the intraoperative appearance considered a reference standard in the diagnosis of endometriosis. Our study revealed the highest specificity for MRI in the case of endometriotic bladder invasion, respectively the highest sensitivity for endometriotic rectal nodules.

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