Diagnostic accuracy of physician-staffed emergency medical teams: a retrospective observational cohort study of prehospital versus hospital diagnosis in a 10-year interval

• Published in: Scandinavian journal of trauma, resuscitation and emergency medicine resuscitation and emergency medicine, 2019-04, Vol.27 (1), p.36-9, Article 36
• Main Authors: Schewe, Jens-Christian, Kappler, Jochen, Dovermann, Katharina, Graeff, Ingo, Ehrentraut, Stefan Felix, Heister, Ulrich, Hoeft, Andreas, Weber, Stefan Ulrich, Muenster, Stefan
• Format: Article
• Language: English
• Subjects: Accuracy; Acute coronary syndromes; Adolescent; Adult; Aged; Aged, 80 and over; Ambulatory care; Cohort analysis; Cohort Studies; Comparative analysis; Coronary heart disease; Death; Diagnosis; Diagnostic accuracy; Diagnostic Errors - statistics & numerical data; Diagnostic services; Disease; Dyspnea; Elderly patients; Emergency medical care; Emergency Medical Services; Emergency medicine; Emergency physicians; Evaluation; Germany; Hospitals; Humans; Medical care quality; Medical diagnosis; Medical personnel; Medical treatment; Mental disorders; Middle Aged; Observational studies; Original Research; Paramedics; Patients; Physician-staffed medical emergency teams; Physicians; Physicians - statistics & numerical data; Prehospital emergency care; Regression analysis; Retrospective Studies; Statistics; Stroke; Young Adult
• ISSN: 1757-7241; 1757-7241
• DOI: 10.1186/s13049-019-0617-3

In Germany, emergency medical teams are staffed with physicians but evidence regarding their prehospital diagnostic accuracy remains poor. To evaluate the out-of-hospital diagnostic accuracy of physician-staffed emergency medical teams (PEMTs). A retrospective observational cohort study involving the Emergency Medical Service Bonn, Germany, from January to December 2004 and 2014 respectively. A total of 8346 patients underwent medical treatment by PEMTs, of which 1960 adult patients (inclusion criteria: ≥18 years of age, hospital diagnosis available) were included for further analysis. Reasons for non-inclusion: death on scene, outpatient, interhospital transfer, mental illness, false alarm, no hospital medical history available. The overall diagnostic accuracy (correct or false) of PEMTs was measured after matching the prehospital diagnosis with the corresponding diagnosis of the hospital. Secondary outcome measures were incidence of common PEMT diagnoses (acute coronary syndrome (ACS), dyspnea, stroke/intracerebral bleeding), recognition rate of a given disease by PEMTs, and prehospital diagnostic accuracy in elderly patients. PEMT calls increased 2-fold over a decade (2004: n = 3151 vs. 2014: n = 5195). Overall diagnostic accuracy of PEMTs increased from 87.5% in 2004 to 92.6% in the year 2014. The incidence of common PEMT diagnoses such as ACS, dyspnea or stroke/intracerebral bleeding increased 2-fold from 2004 to 2014. The recognition rate of a given disease by the PEMT varied between 2004 and 2014: an increase was observed when a stroke/intracerebral bleeding was diagnosed (2004: 67% vs. 2014: 83%; p = 0.054), a decreased rate of recognition occurred when a syncope/collapse was diagnosed (2004: 81% vs. 2014: 56%; p = 0.007) and a sepsis appears to be a rare event for EMS personnel (2004: 0% vs. 2014: 23%). Linear regression analysis revealed that the prehospital diagnostic accuracy decreases in the elderly patient. The overall prehospital diagnostic accuracy of PEMTs improved between the year 2004 and 2014 respectively. Our findings suggest that the incidence of common diseases (ACS, dyspnea stroke/intracerebral bleeding, sepsis) increased over a 10-year period. Diagnostic accuracy of different diseases varied but generally decreased in the elderly patient. Regular training of EMS personnel and public campaigns should be implemented to improve the diagnostic accuracy in the future.