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J Korean Soc Emerg Med > Volume 34(1); 2023 > Article
Journal of The Korean Society of Emergency Medicine 2023;34(1): 20-30.
뇌졸중 환자의 병원 전 의식수준에 따른 119구급대원의 병원 전 뇌졸중 평가 결과 분석
정영주1 , 이선영2,3,4 , 박정호1,4,5 , 김기홍1,4,5
1서울대학교병원 응급의학과
2서울대학교병원 공공진료센터
3서울대학교 의과대학 의학과
4서울대학교병원 의생명연구원 응급의료연구실
5서울대학교 의과대학 응급의학교실
Effect of prehospital patient consciousness level on prehospital stroke screening by emergency medical service provider of stroke patient
Young ju Jeong1 , Sun Young Lee2,3,4 , Jeong Ho Park1,4,5 , Ki Hong Kim1,4,5
1Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
2Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
3Seoul National University College of Medicine, Seoul, Korea
4Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
5Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
Correspondence  Sun Young Lee ,Tel: 02-2072-0865, Fax: 02-741-7855, Email: sy2376@snu.ac.kr,
Received: April 28, 2022; Revised: August 15, 2022   Accepted: August 24, 2022.  Published online: February 28, 2023.
ABSTRACT
Objective:
Stroke detection at the prehospital stage is critically important for the provision of rapid treatment to stroke patients. This study aimed to evaluate the effect of patient consciousness level on prehospital stroke screening (PSS) by the emergency medical service (EMS) provider.
Method:
This retrospective cross-sectional study was conducted using data collected from a linked database of NEDIS (National Emergency Department Information System) and the EMS database in three hospitals. Adult stroke patients who were admitted into the emergency department (ED) using 119 EMS ambulances from 2014 to 2018 were included. The prehospital level of consciousness of patients was evaluated by the EMS provider, and they were divided into two treatment groups: an alert group and a non-alert group (verbal, painful, and unresponsive). The study outcomes were positive results of PSS: the Los Angeles Prehospital Stroke Scale (LAPSS) and Cincinnati Prehospital Stroke Scale (CPSS). Logistic regression analysis was conducted to evaluate the effect of prehospital consciousness level on the PSS result.
Results:
A total number of 3,422 stroke patients were included. The positive rate of LAPSS was 17.0% in the alert group and 8.8% in the non-alert group. The positive rate of CPSS was 35.7% in the alert group and 21.3% in the non-alert group. In the adjusted logistic regression model, in the non-alert group, the adjusted odds ratio (AOR) for LAPSS was 0.47 (95% confidence interval [CI], 0.38-0.59) and the AOR for positive CPSS was 0.49 (95% CI, 0.42-0.57).
Conclusion:
Low consciousness level patients had lower detection of stroke by the EMS provider. EMS provider employees need additional training to achieve more effective detection of stroke in low consciousness level patients.
Key words: Emergency medical services; Transportation of patients; stroke
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