Prehospital Emergency Care最新文献

{"title":"Genre of Music Festivals as a predictor for Medical Utilization Rate.","authors":"G D van Dijken, J S W R Hofsteede, A E Hoek, D Dekker, D W de Lange","doi":"10.1080/10903127.2025.2481143","DOIUrl":"https://doi.org/10.1080/10903127.2025.2481143","url":null,"abstract":"<p><strong>Objectives: </strong>The Medical Utilization Rates (MUR) can be applied to anticipate necessary medical resources at mass gatherings. The MUR describes the number of patients per thousand attendees. The aim of this observational study was to evaluate whether the type of music festival, Electronic Dance Music Festivals (EDMF) versus Mainstream, is related to the MUR and to drug-related incidents.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of patient data from Event Medical Service B.V., a Dutch company, providing emergency care at many festivals in the Netherlands. Data were collected in an online database between February 2022 and August 2023. The number of patient contacts per festival type was recorded and patients requiring advanced medical care (unable to sit, potentially hemodynamically unstable and/or requiring advanced medical care), were analyzed for drug-related causes.</p><p><strong>Results: </strong>A total of 20,829 patients presented at 518 events with a total attendance of almost 7.5 million visitors. There were 253 EDMF events with a median attendance of 12,000 and 265 mainstream events with a median attendance of 10,000 per event. The average MUR for the EDMF group was higher compared to the Mainstream group (28.8 vs. 17.8, p <0.001). A total of 1732 patients needed advanced medical care. The proportion of drug<b>-</b>related cases among the patients needing advanced medical care, mainly stimulants and combined drug use, was 74% for the EDMF group compared to 52% in the mainstream group (p <0.001).</p><p><strong>Conclusions: </strong>In this observational study we found a clear difference in MUR in Electronic Dance Music events compared to Mainstream events with a higher percentage of drug-related cases in patients with more severe conditions at EDMF events. Our findings may help to better plan scarce medical resources at mass gatherings in the music scene and suggest that EDMF need a targeted approach for more drug-related pathology.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143721125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bystander Defibrillation and Survival According to Emergency Medical Service Response Time After Out-of-Hospital Cardiac Arrest - A nationwide registry-based cohort study.","authors":"Mathias Hindborg, Harman Yonis, Filip Gnesin, Mikkel Porsborg Andersen, Frank Eriksson, Zehao Su, Fredrik Folke, Kristian Bundgaard Ringgren, Carolina Malta Hansen, Helle Collatz Christensen, Kristian Kragholm, Christian Torp-Pedersen","doi":"10.1080/10903127.2025.2478211","DOIUrl":"https://doi.org/10.1080/10903127.2025.2478211","url":null,"abstract":"<p><strong>Objectives: </strong>The impact of emergency medical services (EMS) response times when integrating bystanders' automated external defibrillator (AED) use into established response systems remains unclear. This study aims to investigate 30-day survival probabilities for different EMS response times for bystander and non-bystander defibrillated patients and identify for which EMS response times bystander defibrillation improves 30-day survival probability.</p><p><strong>Methods: </strong>Data on patients with bystander witnessed out-of-hospital-cardiac arrest (OHCAs) with initial shockable rhythm who received bystander cardiopulmonary resuscitation were retrieved from Danish Cardiac Arrest Registry for years 2016-2022. Proportions of 30-day survival were calculated for five intervals of EMS response time for patients who received bystander defibrillation and those who did not. The causal inference framework utilizing targeted maximum likelihood estimation was used to estimate 30-day survival probability for each interval of EMS response time and when comparing cases where bystander defibrillation was performed with those where it was not. This analysis was adjusted for relevant confounding factors and conducted separately for residential and public OHCAs.</p><p><strong>Results: </strong>The study included 3,924 patients with OHCA. Bystander defibrillation was more frequent in public than in residential OHCAs (64.1% vs. 35.9%). Short EMS response times had higher 30-day survival probability. Bystander defibrillation resulted in higher probability of 30-day survival for EMS response times of 7-9 minutes (survival ratio 1.24 (95% CI: 1.03; 1.49)) in public OHCAs in the adjusted model, when compared to non-bystander defibrillated patients.</p><p><strong>Conclusions: </strong>With EMS response times of 7-9 minutes, we detected a clear 30-day survival benefit for bystander defibrillated patients in public locations. No 30-day survival benefits were seen for other EMS response time intervals or in residential locations.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Post-opioid overdose response team intervention barriers and facilitators to substance use treatment: Perspectives of patients and team members.","authors":"Rebecca J McCloskey, Alexander J Ulintz, Gretchen Clark Hammond, Jennifer L Brown, Matthew Parrish, Isaac Toliver","doi":"10.1080/10903127.2025.2479569","DOIUrl":"https://doi.org/10.1080/10903127.2025.2479569","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency medical services (EMS) frequently respond to patients with opioid-related overdoses but often lack the infrastructure and capacity to provide resources and support to individuals who decline transportation to the emergency department. Post-overdose response teams pair EMS clinicians with other first responders or substance use treatment professionals to provide outreach, harm reduction materials, and recovery resources. We aimed to explore the experiences of post-overdose patients and team members to better inform a prehospital care intervention and outcomes for patients with opioid use disorder.</p><p><strong>Methods: </strong>This exploratory case study was part of a larger program evaluation of the Rapid Response Emergency and Addiction Crisis Team (RREACT) and describes the barriers and facilitators to accessing substance use recovery resources from the perspective of former patients (<i>n</i> = 8, called program alumni) and RREACT team members (<i>n</i> = 19) in Columbus, OH, USA. Semi-structured interviews were conducted between October 2019 and August 2020. We used inductive thematic analysis to identify key themes by participant group. Themes were compared for similarities and differences. Member checking with team members, peer debriefing, and triangulation of data were used to increase the trustworthiness of the findings.</p><p><strong>Results: </strong>Four overall themes were identified: fear, relationships, resources, and stigma. For program alumni, the fear of withdrawal symptoms was categorized as a barrier to treatment, while the fear of death was a facilitator. Positive relationships between alumni and RREACT team members, among team members, and between RREACT and the community facilitated treatment entry. Additional facilitators of the RREACT intervention were resources in terms of their immediate response and ability to navigate systems. Barriers to RREACT's work included substance use stigma, a lack of appropriate and available treatment services, services only accepting particular insurers, and treatment services for special populations.</p><p><strong>Conclusions: </strong>An EMS-led post-overdose response team provided recovery resources and linkage to treatment by meeting patients in times of desperation, employing non-judgmental personnel, and removing complex barriers. These findings are important to leveraging EMS in expanded roles as part of the larger public health response to opioid overdose.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-18"},"PeriodicalIF":2.1,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143711084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology of Neonate prehospital care at the San Diego (US) - Tijuana (Mexico) International Border.","authors":"Sriyansh Yarlagadda, Michael Hazboun, Gary Vilke, Jennifer Farah, J Joelle Donofrio-Odmann","doi":"10.1080/10903127.2025.2476196","DOIUrl":"https://doi.org/10.1080/10903127.2025.2476196","url":null,"abstract":"<p><strong>Objectives: </strong>Neonates, infants 30 days of age or younger, are understudied in prehospital emergencies. Our objective was to describe prehospital assessment and care for patients <30 days of age at the San Diego-Tijuana Point of Entry (POE). Additional objectives included describing assessments, care, frequency, and level of care for newborns brought to the border by Mexican ambulances.</p><p><strong>Methods: </strong>This was a retrospective analysis from January 1, 2014 to January 01, 2020 of all 9-1-1 calls involving patients <30 days of age at the San Diego POEs. The 9-1-1 responses to newly delivered patients were \"newborns\". Patients who were not immediately post-delivery were \"neonates.\" Patient demographics, response intervals, clinician interventions, and dispositional data were collected from electronic patient records. Descriptive statistics applied.</p><p><strong>Results: </strong>A total of 57 patients <30 days of age were included. With 27 newborn patients, 15 were delivered by EMS personnel (27, 55.6%). Initial APGARs scores were 8-10 in 44.4% and 5-7 in 29.6%. Procedures include newborn care (88.9%), advanced life support (ALS) assessment (63.0%), and warming (59.3%). There were 5 patients that had stimulation, 7 received oxygen, and 3 received Bag-Valve-Mask (BVM) ventilation. No serial heart rates were documented. Regarding 30 neonates, the predominant method of transport to the POE was Mexican ambulance (n 16, 53.3%). Medications administered included oxygen (n 16, 53.3%) and albuterol/ipratropium (n 1, 3.3%). Procedures included ALS assessment (n 19, 63.3%), pulse oximetry (n 22, 73.3%) and 3-lead electrocardiogram (n 8, 26.7%). Three patients (10%) received BVM. Mexican Ambulances brought 16 neonates. A physician or nurse was present in 37.5% transfers, 50% incubated, 25% intubated, 37.5% on supplemental oxygen, and 71% had preexisting intravenous access. These were not interfacility transfers but were 9-1-1 activations by U.S. border agents; And 14 neonates did not arrive via Mexican ambulance. Their complaints were respiratory distress (n 7, 50%) and Brief Resolved Unexplained Episode (n 4, 28.6%).</p><p><strong>Conclusions: </strong>We found that 9-1-1 transports at the San Diego-Tijuana POE for patients <30 days were few and involved resuscitation, neonates in Mexican ambulances with specialized equipment, physicians, and unfamiliar medications. Neonates arriving via private transport had respiratory distress and BRUE.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-10"},"PeriodicalIF":2.1,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities of Aspirin Administration for Prehospital Chest Pain and ST Elevation Myocardial Infarctions.","authors":"Anna Maria Johnson, Hei Kit Chan, Renee Johnson, Anastasia S Papin, Daniel C Walter, N Clay Mann, Benjamin Fisher, Larissa Myaskovsky, Ryan M Huebinger","doi":"10.1080/10903127.2025.2473684","DOIUrl":"10.1080/10903127.2025.2473684","url":null,"abstract":"<p><strong>Objectives: </strong>Although disparities exist in aspirin administration for chest pain and ST elevation myocardial infarctions (STEMI), little is known about community-based disparities in aspirin administration for prehospital patients. We evaluated disparities in prehospital aspirin using a national prehospital database.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the 2018-2021 NEMSIS database linked to census data, including adult prehospital encounters. We created two cohorts: dispatch reason of chest pain and identified STEMI on prehospital EKG. We stratified patients based on majority ZIP Code race/ethnicity (>50% White, Black, and Hispanic) and into quartiles based on household income. Using multivariable logistic regression, we evaluated the association between incident community characteristics and aspirin administration.</p><p><strong>Results: </strong>We included 4,881,663 chest pain encounters and 184,610 STEMIs. Chest pain encounters in majority White communities (32.3%) received aspirin more often for chest pain than Black (22.1%; aOR 0.59, [0.59-0.60]) or Hispanic (24.8%; aOR 0.66, [0.66-0.67]) communities. Compared to the top income quartile (29.0%), the lowest income quartile had lower odds of aspirin administration (4th-27.6%; aOR 0.93, [0.92-0.94]). For STEMIs, adjusted odds of aspirin administration were higher for White (53.4%) than Black (52.5%; aOR 0.81, [0.78-0.84]) or Hispanic (53.6%; aOR 0.93, [0.89-0.96]) patients. Compared to the highest income quartile (55.0%), lower quartiles had lower odds of aspirin administration (2nd-54.2%; aOR 0.95, [0.92-0.97]; 3rd-52.9%; aOR 0.93, [0.91-0.96]; 4th-52.0%; aOR 0.86, [0.84-0.89]).</p><p><strong>Conclusions: </strong>Patients from Black, Hispanic/Latino, and lowest-income communities received aspirin for chest pain at a lower rate than white or high-income patients.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-7"},"PeriodicalIF":2.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency Medical Services (EMS) Clinician Perspectives on the Pediatric Observation Priority Score (POPS).","authors":"Caleb E Ward, Daniel X Zhang, Judith Singletary, Damian Roland, James M Chamberlain","doi":"10.1080/10903127.2025.2477213","DOIUrl":"10.1080/10903127.2025.2477213","url":null,"abstract":"<p><strong>Objectives: </strong>Approximately 50% of children assessed by emergency medical services (EMS) in the United States (U.S.) have no emergent needs. The lack of validated triage tools to identify children at low risk of deterioration without transport is one reason that children have not been included in most alternative disposition programs. The Pediatric Observation Priority Score (POPS) is a triage tool incorporating vital signs and clinical observations. British prehospital studies show the POPS accurately identifies low-acuity children. The POPS has not been assessed in the U.S. Our objective was to determine whether U.S. EMS clinicians find the POPS acceptable, appropriate, and feasible.</p><p><strong>Methods: </strong>We conducted a mixed methods study with EMS clinicians. Participants were provided with an overview of the POPS then completed a survey using the validated Acceptability, Appropriateness, and Feasibility of Implementation Measures (12 Likert-scale questions [1 = strongly disagree to 5 = strongly agree]). We calculated mean question scores. A PhD-trained facilitator conducted cognitive interviews with a subset of participants to explore their perception of the POPS. Multiple investigators coded transcripts until we reached thematic saturation.</p><p><strong>Results: </strong>We recruited 100 participants (51% paramedics, 48% emergency medical technician (EMTs)) with a median (IQR) of 5 years (3, 9) clinical experience. Individual question mean scores across all domains ranged from 4.4-4.6. Paramedic and EMT responses were similar. 10 participants completed interviews and agreed the POPS was acceptable, appropriate, and feasible. Positive themes from analysis included: (1) ease of use and (2) helpful additional tool. Facilitators to implementation included (1) embedding the POPS in documentation systems (2) with a force function, (3) positive messaging, and (4) incorporating the POPS in protocols. Implementation barriers included (1) resistance to mandatory documentation, (2) undermining professional standing, (3) impaired rapport with patients, (4) uncertainty about integration with protocols, (5) and concern about legal liability. Participants suggested changes in wording and question order to improve usability.</p><p><strong>Conclusions: </strong>Prehospital clinicians in the U.S. find the POPS acceptable, appropriate, and feasible for implementation with minor modifications. Further research is needed to determine whether EMS clinicians can accurately apply the POPS in controlled and field settings before implementation.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-8"},"PeriodicalIF":2.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143575818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation Barriers of Prehospital Buprenorphine Administration Programs in the United States: A Scoping Review.","authors":"Mirinda Ann Gormley, Phillip Moschella, Tina Pham, Victoria Callicott, Kyle Jardim, Austin Madden, Wesley R Wampler, Daniel Schwerin, Shuchin Shukla, David A Miramontes, Parker Bailes, Alain H Litwin, Sarah B Floyd, Gerald Wook Beltran","doi":"10.1080/10903127.2025.2470965","DOIUrl":"10.1080/10903127.2025.2470965","url":null,"abstract":"<p><strong>Objectives: </strong>Prehospital buprenorphine administration programs (PBAPs) have spread throughout the United States (U.S.) with limited information on their locations or barriers to implementation, posing challenges to emergency medical services (EMS) systems adopting this clinical care model. This scoping review identifies where current PBAPs operate and summarizes commonly reported barriers to PBAP implementation.</p><p><strong>Methods: </strong>State Offices of EMS were contacted by phone and email and asked if PBAPs operated within the state. After three failed attempts, representative physicians from remaining states were queried through the National Association of EMS Physicians' state membership. Four databases identified PBAPs from manuscripts, popular media, and conference proceedings from each database's inception to 8/25/2024. Programs were included if EMS clinicians administered buprenorphine. Data extraction from academic manuscripts, popular media, and conference proceedings included PBAP location, personnel, protocols, and implementation barriers. Results were reported utilizing Preferred Reporting Items for Systematic Reviews and Meta Analyses extension for Scoping Reviews.</p><p><strong>Results: </strong>Nineteen states and Washington D.C. reported at least one PBAP, 28 reported none, 3 were pending implementation. Of 977 identified titles, 17 met inclusion criteria. Seven media articles, 4 conference presentations, 3 cohort studies, 2 case series, and 1 scoping review yielded data on 13 unique PBAPs within 8 states. Most PBAPs delivered buprenorphine <i>via</i> 9-1-1 paramedics (61.5%) during an EMS response, or by community paramedics (46.1%) within 24-48 h of an EMS response to a patient who experienced an overdose. Five (33.3%) PBAPs reported at least one patient-related barrier to PBAP implementation, including reasons buprenorphine was not administered, lack of treatment access, and patient loss of follow-up. Four programs reported operational-level barriers, including in-person restrictions due to COVID-19, siloing of outpatient services, lack of outpatient service options, inconsistent education of PBAP staff, inconsistent application of PBAP protocols by EMS clinicians, high turnover, and difficulty procuring buprenorphine.</p><p><strong>Conclusions: </strong>Whereas 19 states in the U.S. and Washington D.C. reported having at least one PBAP, few are reported in literature, and very few report barriers to PBAP implementation. Developing consensus on metrics assessing PBAP implementation is necessary to inform EMS agencies implementing these novel programs throughout the U.S.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prehospital Blood Lactate Measurements in Ambulances and Associations with Outcomes: A Cohort Study.","authors":"Louise H Walther, Erika F Christensen, Annmarie T Lassen, Christian B Mogensen, Søren Mikkelsen","doi":"10.1080/10903127.2025.2473034","DOIUrl":"10.1080/10903127.2025.2473034","url":null,"abstract":"<p><strong>Objectives: </strong>The prehospital use of blood lactate measurements is increasing. The blood lactate level is a well-recognized biomarker of poor outcomes, mainly investigated in potentially critically ill patients or patients with specific illnesses. However, evidence of a correlation in a broad prehospital setting with undifferentiated patients is lacking. This study aimed to investigate the correlation between prehospital blood lactate levels and the risks of poor outcomes in undifferentiated prehospital patients with apparent non-life-threatening conditions.</p><p><strong>Methods: </strong>This was a large cohort study of undifferentiated prehospital patients aged ≥18 years old who required intravascular accesses during prehospital care from February 3 to June 14, 2020. StatStrip Xpress Lactate Meter analyzed the lactate levels. The primary outcome was the risk of 7-day mortality. Follow-up was 90 days. The categorical secondary outcomes were 30-day and 90-day mortality risks and risks of mechanical ventilation, vasopressor treatment, or acute renal replacement therapy. Other secondary outcomes were the number of days alive within 30 days outside the hospital, outside the intensive care unit, and without mechanical ventilation. The primary analyses were uni- and multivariate logistic regressions presented as odds ratios (OR) with 95% confidence intervals (CI) and p-values.</p><p><strong>Results: </strong>The study included 11,515 patients. The overall 7-day mortality rate was 3.1%. The 7-day mortality rates were 2.0%, 3.6%, and 12.8% in patients with lactate levels of <2.0 mmol/L, 2.0-3.9 mmol/L and ≥4.0 mmol/L, respectively. The risk of 7-day mortality increased with elevated lactate level, OR = 1.43 (95% CI: 1.36-1.51), <i>p</i> < 0.001. The ORs were similar in all prespecified diagnostic subgroups except for patients receiving diagnoses within the nervous system. Patients with elevated lactate levels had increased risks of all categorical secondary outcomes. They stayed longer in the hospital, in the intensive care unit, and on mechanical ventilation than the patients with normal prehospital lactate levels.</p><p><strong>Conclusions: </strong>: This study found evidence of correlations between elevated lactate levels and poor outcomes in all acute prehospital patients except patients receiving diagnoses within the nervous system. Implementing prehospital lactate measurements is useful if knowledge of the patient's lactate levels adds to existing parameters in the prehospital setting.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Compliance Evaluation with ChatGPT for Diagnosis and Treatment in Patients Brought to the ED with a Preliminary Diagnosis of Stroke.","authors":"Merve Yazla, Emine Sarcan","doi":"10.1080/10903127.2025.2475513","DOIUrl":"10.1080/10903127.2025.2475513","url":null,"abstract":"<p><strong>Objectives: </strong>Chat Generative Pre-trained Transformer (ChatGPT) is a natural language processing product developed by OpenAI. Recently, the use of ChatGPT has gained attention in the field of health care, particularly for its potential applications in diagnostic and decision-making support. While its utility is still being explored, it shows promise as a supplementary tool in these contexts. This study aims to evaluate the potential of ChatGPT in making decisions about 'transportation to the stroke center, suspicion of large vessel occlusion and treatment decisions' of patients brought to the emergency department by ambulance with a preliminary diagnosis of stroke.</p><p><strong>Methods: </strong>All patients with a stroke code who were transferred to the emergency department (ED) of a tertiary care hospital, Ankara Etlik City Hospital, by ambulance between November 1, 2023, and April 30, 2024, during designated stroke team coverage periods were included in the study. Unlike many stroke centers that operate continuously 24/7, our institution follows a structured on-call system, where specialized stroke teams are assigned time slots to provide stroke care. Data were collected from prehospital records, ED notes, and hospital imaging and treatment records. ChatGPT's decisions were compared to gold standard outcomes using Cohen's kappa test, with sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) calculated for each directive.</p><p><strong>Results: </strong>A total of 512 patients were analyzed, and ChatGPT's decisions were compared with the patients' final diagnoses and treatments. Analysis comparing ChatGPT's decisions to patient outcomes across prehospital stroke suspicion, large vessel occlusion diagnosis, and treatment phases showed significant agreement (<i>p</i> < 0.001, Kappa: 0.540-0.562). While the sensitivity of the diagnosis of stroke was 91%, the NPV was found to be 98% in patients requiring intravenous tissue plasminogen activator and large vessel occlusion, 97% NPV in patients requiring mechanical thrombectomy.</p><p><strong>Conclusions: </strong>ChatGPT shows promise as a decision-support tool for identifying acute ischemic stroke and determining treatment needs in prehospital and ED settings. However, its reliance on predefined data highlights the need for physician supervision to address clinical complexities and ensure patient safety. Integrating ChatGPT as an adjunct rather than a standalone system can enhance decision-making efficiency while maintaining high-quality care.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-9"},"PeriodicalIF":2.1,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143557790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Creation of a Novel National Dataset Through Linkage of Emergency Medical Services (EMS) Transport Destination and Verified Emergency Department (ED) Capability.","authors":"Rebecca E Cash, Remle P Crowe, Maeve Swanton, Krislyn M Boggs, Scott A Goldberg, Ashley F Sullivan, Carlos A Camargo, Kori S Zachrison","doi":"10.1080/10903127.2025.2470286","DOIUrl":"10.1080/10903127.2025.2470286","url":null,"abstract":"<p><strong>Objective: </strong>Emergency department (ED) capabilities, such as trauma center or stroke center designation, are key to understanding the effects of emergency medical services (EMS) transport destination decisions on patient outcomes. In current EMS datasets, ED capabilities are self-reported by the EMS clinician or agency. The reliability and validity of the EMS-reported ED capabilities is unknown. Our objective was to link EMS transport destinations with verified ED capability data to develop a novel national dataset to better understand prehospital routing practices.</p><p><strong>Methods: </strong>We linked two cross-sectional databases: the 2021 ESO Data Collaborative and the 2021 National Emergency Department Inventory (NEDI)-USA. The ESO Data Collaborative contains de-identified prehospital patient care records from nearly 2,000 participating EMS agencies across the United States. The NEDI-USA is a survey of all nonfederal, non-specialty U.S. EDs open 24/7/365 (including freestanding EDs), with verified stroke, trauma, and burn capability data. From EMS records, we obtained all unique destinations designated as \"hospital\" as of 2021. After verifying addresses were NEDI-eligible EDs (i.e., providing emergency services 24/7/365), we performed a 3-step linkage process to NEDI-USA: (1) name/address exact matches; (2) probabilistic matching on name/address based on bigrams, accepting adequate (>85%) match scores after review; and (3) hand-matching using Google Maps. We calculated descriptive statistics to describe the linkage process.</p><p><strong>Results: </strong>Of the 9,420 unique \"hospital\" destinations in the EMS dataset, 2,714 (29%) were non-hospital facilities (e.g., nursing home) or were non-NEDI-eligible (e.g., specialty hospital such as a psychiatric facility). We linked 98% (<i>n</i> = 6,605/6,706) of NEDI-eligible EMS hospital transport destinations to EDs in NEDI-USA. Excluding duplicate addresses for a single hospital (e.g., ED address versus main entrance address), the linked addresses represented 3,877 unique EDs in 49 states, which included 68% (<i>n</i> = 3,821/5,580) of the EDs included in the 2021 NEDI-USA database.</p><p><strong>Conclusions: </strong>We successfully linked 98% of EMS ED transport destinations to verified ED capability information. This novel linked dataset now includes rich destination capability information associated with each EMS transport that can be leveraged for describing and improving routing practices for specific patient conditions, such as patients with stroke-like symptoms to stroke centers or major traumas to verified trauma centers.</p>","PeriodicalId":20336,"journal":{"name":"Prehospital Emergency Care","volume":" ","pages":"1-6"},"PeriodicalIF":2.1,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143468777","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}