背景:紧急医疗服务(EMS)专业人员认为非运输的临床决策复杂且困难。基于晕厥的短暂意识丧失(TLOC)的患者构成了非运输人群的重要组成部分。风险分层是EMS专业人员进行临床决策过程的基础。这种风险分层基于各种患者因素。这项研究旨在探讨基于晕厥的TLOC患者的EMS专业人员与运输决策显着相关的患者因素。
方法:进行了具有析因调查设计的横截面插图研究。患者因素来自“国家协议救护车护理”,这些因素和基本类别的所有可能组合都被组合在一起,导致256个独特的插图(2*4*4*4*2=256)。患者因素表现为不良事件的低风险或高风险因素。数据是通过在线问卷收集的,参与者接受了15个小插图的随机样本。对于每个小插图,受访者指出患者是否需要被送往急诊科。进行了逐步向后消除的多水平逻辑回归分析,以分析与运输决策显着相关的因素。在逻辑模型中,我们对不运输的概率进行了建模。
结果:包括110名受访者,1646个小插曲正在评估中。平均年龄45.5(标准差9.3),男性63.6%,和多年的经验13.2(SD8.9)。多水平分析显示,两个患者因素对运输决策有重要影响:“危险信号”和“院前心电图(ECG)”。在这些患者因素中,三个基本类别与非运输显着相关:家族史中<40岁的心脏性猝死(OR0.33,95%CI0.22-0.50;p<0.001),心血管异常,病史中的肺栓塞或肺动脉高压(OR0.62,95%CI0.43-0.91;p=0.01),和“院前心电图异常”(OR0.54,95%CI0.41-0.72;p<0.001)。
结论:家族史中<40岁的心脏猝死,病史,在基于晕厥的TLOC患者中,异常的ECG与EMS专业人员的非运输决策显着负相关。低风险因素在运输决策中作用不大。
The clinical decision-making of non-conveyance is perceived as complex and difficult by emergency medical services (EMS) professionals. Patients with a transient loss of consciousness (TLOC) based on syncope constitute a significant part of the non-conveyance population. Risk stratification is the basis of the clinical decision-making process by EMS professionals. This risk stratification is based on various patient factors. This study aimed to explore patient factors significantly associated with conveyance decision-making by EMS professionals in patients with a TLOC based on syncope.
A cross-sectional vignette study with a factorial survey design was conducted. Patient factors were derived from the \"National Protocol Ambulance Care\", and all possible combinations of these factors and underlying categories were combined, resulting in 256 unique vignettes (2*4*4*4*2 = 256). Patient factors presented either low-risk or high-risk factors for adverse events. Data were collected through an online questionnaire, in which participants received a random sample of 15 vignettes. For each vignette, the respondent indicated whether the patient would need to be conveyed to the emergency department or not. A multilevel logistic regression analysis with stepwise backward elimination was performed to analyse factors significantly associated with conveyance decision-making. In the logistic model, we modelled the probability of non-conveyance.
110 respondents were included, with 1646 vignettes being assessed. Mean age 45.5 (SD 9.3), male gender 63.6%, and years of experience 13.2 (SD 8.9). Multilevel analysis showed two patient factors contributing significantly to conveyance decision-making: \'red flags\' and \'prehospital electrocardiogram (ECG)\'. Of these patient factors, three underlying categories were significantly associated with non-conveyance: \'sudden cardiac death < 40 years of age in family history\' (OR 0.33, 95% CI 0.22-0.50; p < 0.001), \'cardiovascular abnormalities, pulmonary embolism or pulmonary hypertension in the medical history\' (OR 0.62, 95% CI 0.43-0.91; p = 0.01), and \'abnormal prehospital ECG\' (OR 0.54, 95% CI 0.41-0.72; p < 0.001).
Sudden cardiac death < 40 years of age in family history, medical history, and abnormal ECG are significantly negatively associated with non-conveyance decision-making by EMS professionals in patients with a TLOC based on syncope. Low-risk factors do not play a significant role in conveyance decision-making.