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Eichinger M, Reiterer S, Rief M, Eichlseder M, Pichler A, Zoidl P, Prause G. Use of bitemporal NACA score documentation in prehospital emergency medical services- a retrospective study. Int J Emerg Med 2024; 17:36. [PMID: 38454355 PMCID: PMC10918989 DOI: 10.1186/s12245-024-00605-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/22/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND The assessment of illness severity in the prehospital setting is essential for guiding appropriate medical interventions. The National Advisory Committee for Aeronautics (NACA) score is a validated tool commonly used for this purpose. However, the potential benefits of using bitemporal documentation of NACA scores to capture the dynamic changes in emergency situations remain uncertain. The objective of this study was to evaluate the potential benefit of bitemporal NACA score documentation in the prehospital setting, specifically in assessing the dynamic changes of emergencies and facilitating quality improvement through enhanced documentation practices. METHODS In this retrospective study, data from prehospital emergency patients were analyzed who received care from the physician response unit between January 1, 2018, and May 31, 2021. Patient demographics, NACA scores, indications for emergency care, and changes in NACA scores were extracted from medical records. Statistical analyses were performed to examine the associations between NACA scores, emergency categories, indications, and changes in NACA scores. RESULTS The study included 4005 patients, predominantly categorized as NACA III (33.7% at initial assessment, 41.8% at subsequent assessment) and NACA IV (31.6% at initial assessment, 22.4% at subsequent assessment). There was a significant improvement in NACA scores during the provision of prehospital care (p < 0.01). Notably, prehospital emergencies attributed to internal medical, neurological, traumatic, and paediatric causes demonstrated significant improvements in NACA scores (p < 0.01). Gender-specific differences were also observed. CONCLUSION Our study suggests that the bitemporal documentation of NACA scores can be advantageous in the prehospital setting and may have implications for research, practice, and policy.
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Affiliation(s)
- Michael Eichinger
- Division of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria
| | - Sandro Reiterer
- Division of Anaesthesiology and Intensive Care Medicine 2, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria
| | - Martin Rief
- Division of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria.
| | - Michael Eichlseder
- Division of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria
| | - Alexander Pichler
- Division of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria
| | - Philipp Zoidl
- Division of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria
| | - Gerhard Prause
- Division of Anaesthesiology and Intensive Care Medicine 1, Medical University of Graz, Auenbruggerplatz 5, Graz, A-8036, Austria
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Leszczyński PK, Wejnarski A, Rzońca P, Gajowniczek A, Gałązkowski R, Mitura K, Sholokhova D. Arrhythmias Occurring in Children during HEMS Intervention: A Retrospective Cohort Study. Emerg Med Int 2023; 2023:2974648. [PMID: 38046470 PMCID: PMC10689065 DOI: 10.1155/2023/2974648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023] Open
Abstract
Background Arrhythmias in patients during medical transport remain a challenge for medical personnel. Helicopter emergency medical service (HEMS) crews, as the only medical rescue teams in Poland to conduct rescue flights, keep detailed documentation of monitoring vital functions over short time intervals during the flight. Aims The aim of this study was to determine the characteristics of cardiac arrhythmia in pediatric patients (up to 12 years of age) transported by HEMS operatives, considering life-threatening rhythms and those that occur during out-of-hospital cardiac arrest (OHCA). Methods The analysis of HEMS medical documentation covered 90345 missions carried out from 2011 to 2020. Among all activations, 820 cases of arrhythmias in pediatric patients up to 12 years of age were extracted. Results Missions for males accounted for 60% of all activations (n = 492), while flights for females accounted for 40% (n = 328). A statistically significant relationship between the number of HEMS flights and the season was demonstrated (p = 0.015). During the study period, pediatric patients mostly experienced cardiac arrhythmias in the form of supraventricular tachycardia (sVT) (n = 504). Asystole (n = 178) and pulseless electrical activity (PEA) (n = 52) ranked second and third in terms of occurrence, respectively. A statistically significant relationship between the type of heart rhythm disorder and age was demonstrated (p < 0.05). Conclusions Heart rhythm disorders most often affected children between 0 and 3 years of age. As the patient's age increased, the incidence of arrhythmias decreased. Among pediatric patients, supraventricular tachycardia proved to be the predominant arrhythmia during the study period.
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Affiliation(s)
| | - Arkadiusz Wejnarski
- Faculty of Medical Sciences and Health Sciences, University of Siedlce, Siedlce, Poland
| | - Patryk Rzońca
- Department of Human Anatomy, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| | | | - Robert Gałązkowski
- Faculty of Medical Sciences and Health Sciences, University of Siedlce, Siedlce, Poland
| | - Kryspin Mitura
- Faculty of Medical Sciences and Health Sciences, University of Siedlce, Siedlce, Poland
| | - Daryna Sholokhova
- Faculty of Medical Sciences and Health Sciences, University of Siedlce, Siedlce, Poland
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Chappuis VN, Deham H, Cottet P, Gartner BA, Sarasin FP, Niquille M, Suppan L, Larribau R. Emergency physician's dispatch by a paramedic-staffed emergency medical communication centre: sensitivity, specificity and search for a reference standard. Scand J Trauma Resusc Emerg Med 2021; 29:31. [PMID: 33563301 PMCID: PMC7871575 DOI: 10.1186/s13049-021-00844-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/29/2021] [Indexed: 12/14/2022] Open
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. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00844-y.
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Affiliation(s)
- Victor Nathan Chappuis
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Hélène Deham
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Philippe Cottet
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Birgit Andrea Gartner
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - François Pierre Sarasin
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Marc Niquille
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Laurent Suppan
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland
| | - Robert Larribau
- Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, CH 1211, Geneva, Switzerland. .,Division of Emergency Medicine, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospital, Chemin du Petit-Bel-Air 2, CH 1226, Geneva, Thônex, Switzerland.
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Dami F, Darioli V, Pasquier M. Association between the NACA score and clinical outcomes. Am J Emerg Med 2020; 38:1692-1693. [PMID: 31954546 DOI: 10.1016/j.ajem.2020.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/10/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Fabrice Dami
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Vincent Darioli
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Mathieu Pasquier
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland.
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