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dc.contributor.authorFuller, Gordon W.
dc.contributor.authorGoodacre, Steve
dc.contributor.authorKeating, Samuel
dc.contributor.authorHerbert, Esther
dc.contributor.authorPerkins, Gavin D.
dc.contributor.authorWard, Matthew
dc.contributor.authorRosser, Andy
dc.contributor.authorGunson, Imogen
dc.contributor.authorMiller, Joshua
dc.contributor.authorBradburn, Mike
dc.contributor.authorHarris, Tim
dc.contributor.authorCooper, Cindy
dc.date.accessioned2021-04-24T13:36:55Z
dc.date.available2021-04-24T13:36:55Z
dc.date.issued2020-12-01
dc.identifier.citationFuller, G. W. et al, 2020. The Diagnostic Accuracy of Prehospital Assessment of Acute Respiratory Failure. British Paramedic Journal, 5 (3), 15-22.en_US
dc.identifier.issn1478-4726
dc.identifier.doi10.29045/14784726.2020.12.5.3.15
dc.identifier.urihttp://hdl.handle.net/20.500.12417/1058
dc.description.abstractAcute respiratory failure (ARF) is a common medical emergency. Pre-hospital management includes controlled oxygen therapy, supplemented by specific management options directed at the underlying disease. The aim of the current study was to characterise the accuracy of paramedic diagnostic assessment in acute respiratory failure. Methods: A nested diagnostic accuracy and agreement study comparing pre-hospital clinical impression to the final hospital discharge diagnosis was conducted as part of the ACUTE (Ambulance CPAP: Use, Treatment effect and Economics) trial. Adults with suspected ARF were recruited from the UK West Midlands Ambulance Service. The pre-hospital clinical impression of the recruiting ambulance service clinician was prospectively recorded and compared to the final hospital diagnosis at 30 days. Agreement between pre-hospital and hospital diagnostic assessments was evaluated using raw agreement and Gwets AC1 coefficient. Results: 77 participants were included. Chronic obstructive pulmonary disease (32.9%) and lower respiratory tract infection (32.9%) were the most frequently suspected primary pre-hospital diagnoses for ARF, with secondary contributory conditions recorded in 36 patients (46.8%). There was moderate agreement between the primary pre-hospital and hospital diagnoses, with raw agreement of 58.5% and a Gwets AC1 coefficient of 0.56 (95% CI 0.43 to 0.69). In five cases, a non-respiratory final diagnosis was present, including: myocardial infarction, ruptured abdominal aortic aneurysm, liver failure and sepsis. Conclusions: Pre-hospital assessment of ARF is challenging, with limited accuracy compared to the final hospital diagnosis. A syndromic approach, providing general supportive care, rather than a specifically disease-orientated treatment strategy, is likely to be most appropriate for the pre-hospital environment. Abstract published with permission.
dc.language.isoenen_US
dc.subjectEmergency Medical Servicesen_US
dc.subjectRespiratory Failureen_US
dc.subjectChronic Obstructive Pulmonary Disease (COPD)en_US
dc.subjectPre-hospital Careen_US
dc.titleThe Diagnostic accuracy of prehospital assessment of acute respiratory failureen_US
dc.source.journaltitleBritish Paramedic Journalen_US
rioxxterms.versionNAen_US
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden_US
rioxxterms.licenseref.startdate2021-01-12
rioxxterms.typeJournal Article/Reviewen_US
refterms.panelUnspecifieden_US
refterms.dateFirstOnline2020-12-01
html.description.abstractAcute respiratory failure (ARF) is a common medical emergency. Pre-hospital management includes controlled oxygen therapy, supplemented by specific management options directed at the underlying disease. The aim of the current study was to characterise the accuracy of paramedic diagnostic assessment in acute respiratory failure. Methods: A nested diagnostic accuracy and agreement study comparing pre-hospital clinical impression to the final hospital discharge diagnosis was conducted as part of the ACUTE (Ambulance CPAP: Use, Treatment effect and Economics) trial. Adults with suspected ARF were recruited from the UK West Midlands Ambulance Service. The pre-hospital clinical impression of the recruiting ambulance service clinician was prospectively recorded and compared to the final hospital diagnosis at 30 days. Agreement between pre-hospital and hospital diagnostic assessments was evaluated using raw agreement and Gwets AC1 coefficient. Results: 77 participants were included. Chronic obstructive pulmonary disease (32.9%) and lower respiratory tract infection (32.9%) were the most frequently suspected primary pre-hospital diagnoses for ARF, with secondary contributory conditions recorded in 36 patients (46.8%). There was moderate agreement between the primary pre-hospital and hospital diagnoses, with raw agreement of 58.5% and a Gwets AC1 coefficient of 0.56 (95% CI 0.43 to 0.69). In five cases, a non-respiratory final diagnosis was present, including: myocardial infarction, ruptured abdominal aortic aneurysm, liver failure and sepsis. Conclusions: Pre-hospital assessment of ARF is challenging, with limited accuracy compared to the final hospital diagnosis. A syndromic approach, providing general supportive care, rather than a specifically disease-orientated treatment strategy, is likely to be most appropriate for the pre-hospital environment. Abstract published with permission.en_US


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