Comparison of Pre-Hospital Preliminary Diagnosis and Definitive Diagnosis in Emergency Department

Yıl 2024, Cilt: 8 Sayı: 1, 32 - 38, 30.04.2024

Yusuf Kantar , Necmi Baykan , Funda İpekten , Melih İmamoğlu

https://doi.org/10.30565/medalanya.1443645

Öz

Aim: In this study, it was examined whether the anamnesis taken by pre-hospital paramedics and the physical examination performed in a limited time were effective as intended in non-trauma patients brought to a secondary level district state hospital by ambulance. In addition, it was evaluated whether appropriate preliminary diagnoses were made during the evaluations and these preliminary diagnoses were compared with the definitive diagnoses made after the examinations performed in the emergency room.

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. Patients referred from another hospital, admitted to another ward for hospitalization and brought to the emergency department with cardiopulmonary arrest were not 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%). When we compared which system in the body the symptoms and preliminary diagnoses considered by the paramedics belonged to and which system the definitive diagnoses made in the emergency department belonged to, it was observed that there was 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 genitourinary system pathologies (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 determined that 74.9% of the case forms stated symptoms instead of preliminary diagnosis. This may be due to paramedics not wanting to take responsibility by stating a more general approach to patient handover.

Anahtar Kelimeler

Definitive diagnosis, Preliminary diagnosis, Emergency department

Hastane Öncesi Konulan Ön Tanı ile Acil Serviste Konulan Kesin Tanıların Karşılaştırılması

Öz

Amaç: Bu çalışmada ambulansla ikinci basamak bir ilçe devlet hastanesine getirilen travma dışı hastalarda hastane öncesi paramediklerin aldığı anemnez ve kısıtlı sürede yaptığı fizik muayenenin hedeflenen etkinliği gösterip göstermediği incelenmiştir. Ayrıca yapılan değerlendirmelerde uygun ön tanıların konulup konulmadığı değerlendirilmiş ve bu ön tanılar acil serviste yapılan muayeneler sonrası konulan kesin tanılarla karşılaştırılmıştır.

Yöntemler: 01.01.2023 ile 30.06.2023 tarihleri arasında bir Devlet Hastanesine ambulans ile getirilen hastalar retrospektif olarak incelendi. Travma dışı nedenlerle sahadan getirilen tüm yaş grupları çalışmaya dahil edildi. Başka bir hastaneden sevk edilen ve kardiyopulmoner arrest ile acil servise getirilen hastalar çalışmaya dahil edilmedi.

Bulgular: Çalışma süresi boyunca acil servisimize ambulans ile getirilen tüm hastalar incelendi. Hastaların yaş ortalaması 66 idi. Olguların yarısından fazlası kadındı (%57,7). Paramedikler tarafından düşünülen semptom ve ön tanıların vücuttaki hangi sisteme dahil oldukları ile acil serviste konulan kesin tanıların hangi sisteme dahil oldukları karşılaştırıldığında, 112 ekipleri tarafından düşünülen patolojiler ile acil servis hekimleri tarafından düşünülen patolojiler arasında genitoüriner sistem patolojileri hariç tüm vücut sistemlerinde istatistiksel olarak orta düzeyde bir uyum olduğu görüldü (Kappa 0.558).

Sonuç: Hastane öncesi acil sağlık hizmetlerinde görev yapan ambulans çalışanlarının vaka formunda belirttikleri ön tanı veya semptomun acil servisteki kesin tanı sistemleri ile benzer olduğu görülmüştür. Ancak vaka formlarının %74,9'unda ön tanı yerine semptom belirtildiği tespit edilmiştir. Bu durum, paramediklerin hasta tesliminde daha genel bir yaklaşım belirterek sorumluluk almak istememelerinden kaynaklanmış olabilir.

Anahtar Kelimeler

Acil tıp, Kesin tanı, Ön tanı

Kaynakça

• 1. Bozatlı SBH. Evaluation of the applications to Trakya University Health Research and Application Center adult emergency service with 112 ambulance. Emergency Department, Faculty of Medicine, Trakya University; 2019.
• 2. Burt CW, Mccaig LF, Valverde RH. Analysis of Ambulance Transports and Diversions among us Emergency Departments. Ann Emerg Med. 2006;47(4):317-26. doi: 10.1016/j.annemergmed.2005.12.001.
• 3. Şimşek P, Günaydın M, Gündüz A. Prehospital Emergency Health Services: the case of Turkey. Gümüşhane University Journal of Health Sciences. 2019;8.1:120-7.
• 4. Yıldırım D, Sarı E, Gündüz S, Yolcu S. The Past and Present of Paramedic Education. Smyrna Medical Journal. 2014;3(1):51-3.
• 5. Çelikli S. Standardization Efforts and Breaking Points in Paramedic Education from Establishment to Today. Journal of Pre-Hospital. 2016;1(2):39-54.
• 6. Lidal IB, Holte HH, Vist GE. Triage Systems for Pre-Hospital Emergency Medical Services-a Systematic Review. Scandinavian journal of trauma, resuscitation and emergency medicine. 2013;21(1):1-6. doi:10.1186/1757-7241-21-28.
• 7. Gökcan Çakır Z, Bayramoğlu A, Aköz A, Esen Türkyılmaz Ş, Emet M, Uzkeser M. Analysis of Patient Forms of Prehospital Emergency Medical Services. JAEM. 2012;11:23-6. doi:10.5152/jaem.2012.016.
• 8. Almacıoğlu ML. Evaluation of transport suitability of patients brought to the Emergency Department of Uludag University Faculty of Medicine by ambulance. PhD Thesis. Bursa Uludag University (Turkey);2011.
• 9. Kızıl M. Anxiety Levels and Work Stressors of Paramedic and Emergency Medical Technicians Working in İzmir 112 Ambulances. Pre-Hospital Journal. 2016;1(1):43-54.
• 10. Sarı A. A Retrospective Study of Sociodemographic Characteristics and Clinical Outcomes of Patients Admitted to the Emergency Department of Pamukkale University Medical Faculty Hospital by 112 Ambulance. Emergency Department, Faculty of Medicine, Trakya University;2020.
• 11. Yıldız M, Durukan P. Analysis of Patients Transported to the Emergency Department by Ambulance. TJEM. 2004;4(4):144-8.
• 12. Weiss SJ, Ernst AA, Phillips J, Hill B. Gender Differences in State-Wide EMS Transports. AJEM. 2000;18(6):666-70. doi: 10.1053/ajem.2000.16299.
• 13. Schull MJ, Morrison LJ, Vermeulen M, Redelmeier DA. Emergency Department Overcrowding and Ambulance Transport Delays for Patients with Chest Pain. CMAJ. 2003;168(3):277-83. PMID: 12566332
• 14. Ertan C, Akgün FS, Yücel N. Investigation of Referrals to a University Hospital Emergency Department. TJEM. 2010;10(2):65-70.
• 15. Yılmaz BK, Çevik E, Dogan HM, Kutur A. 112 Emergency Health Service in the Metropolis. Journal of Istanbul Faculty of Medicine. 2014;77(3):37-40. doi. 10.18017/iuitfd.13056441.2015.77/3.37-40
• 16. Önge T, Satar S, Kozacı N, Açıkalın A, Köseoğlu Z, Gülen M, et al. Analysis of Patients Admitted to the Emergency Medicine Department by the 112 Emergency Service. Journal of Academic Emergency Medicine. 2013;12:150-4. doi: 10.5152/jaem.2013.020
• 17. Duman Atilla Ö, Oray D, Akın Ş, Acar K, Bilge A. View from the Emergency Department: Patients Brought by Ambulance and Consent for Referral. TJEM. 2010;10(4):175-80.
• 18. Yurteri H, Saran A, Özgün İ. Evaluatıon of Cases Received by Emergency Service Ambulances. Ulusal Travma Dergisi. 1996;2.2:204-7.
• 19. Snooks H, Wrigley H, George S, Thomas E, Smith H, Glasper A. Appropriateness of Use of Emergency Ambulances. Journal of accident & emergency medicine.1998;15(4):212. doi: 10.1136/emj.15.4.212