COMPARISON OF PRE-HOSPITAL PRELIMINARY DIAGNOSIS AND DEFINITIVE DIAGNOSIS IN EMERGENCY DEPARTMENT IN PATIENTS BROUGHT BY AMBULANCE

Yusuf Kantar, Necmi Baykan, F. İpekten, Melih Imamoğlu
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Abstract

Aim: In this study, it was evaluated whether the anamnesis taken by paramedics before the hospital and the physical examination performed by paramedics in a limited time in non-traumatic patients brought to a second-level district state hospital by ambulance showed targeted effectiveness and whether the appropriate preliminary diagnosis was made in the evaluations made, and these preliminary diagnoses were compared with the final diagnoses made after the examinations in the emergency department. Methods: Between 01.01.2023 and 30.06.2023, patients brought to a State Hospital by ambulance were retrospectively analyzed. All age groups brought from the field for non-traumatic reasons were included in the study. Results: During the study period, all patients brought to our emergency department by ambulance were examined. The mean age of the patients was 66. More than half of the cases were female (57.7%). Comparison of the body systems belonging to the symptoms and preliminary diagnoses considered by the paramedics with the body systems belonging to the definitive diagnoses made in the emergency department showed a statistically moderate level of agreement between the pathologies considered by the 112 teams and the pathologies considered by the emergency department physicians in all body systems except the pathologies of the genitourinary system (Kappa 0.558). Conclusion: It was observed that the preliminary diagnosis or symptom stated in the case form by ambulance workers working in prehospital emergency health services was similar to the definitive diagnostic systems in the emergency department. However, it was found that 74.9% of the case forms indicated symptoms instead of preliminary diagnosis. This may have been due to the fact that paramedics did not want to take responsibility by stating a more general approach in patient delivery.
救护车送来的病人的院前初步诊断与急诊科明确诊断的比较
目的:在本研究中,对救护车送往国家二级地区医院的非外伤性患者,评估医护人员在入院前采集的病史以及在有限时间内进行的体格检查是否具有针对性效果,在评估中是否做出了适当的初步诊断,并将这些初步诊断与急诊科检查后做出的最终诊断进行比较。方法:对 2023 年 1 月 1 日至 2023 年 6 月 30 日期间由救护车送往国立医院的患者进行回顾性分析。所有年龄组因非外伤原因从外地送来的患者均被纳入研究范围。研究结果在研究期间,所有被救护车送到急诊科的患者都接受了检查。患者的平均年龄为 66 岁。一半以上的病例为女性(57.7%)。将医护人员考虑的症状和初步诊断所属的身体系统与急诊科明确诊断所属的身体系统进行比较后发现,除泌尿生殖系统的病变外,112 小组考虑的病变与急诊科医生考虑的病变在所有身体系统中的一致性在统计学上达到中等水平(Kappa 0.558)。结论据观察,在院前急救医疗服务中工作的救护人员在病例表中填写的初步诊断或症状与急诊科的明确诊断系统相似。然而,研究发现,74.9%的病例表中填写的是症状而不是初步诊断。这可能是由于辅助医务人员不想承担责任,在为病人提供服务时采用较为笼统的方法。
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