医护人员准确区分哮喘和COPD是院前处理的一个难题
2015/04/27
摘要
简介：单独的临床实践指南（CPG）为哮喘和慢性阻塞性肺疾病（COPD）患者的院前护理提供指导。然而，不同的CPGs意味着医护人员能准确地区分不同的情况。我们通过对比急诊科（ED）的出院诊断比较了两种情况下院前诊断的准确性。
方法：2012年7月～2013年6月间，西澳大利亚佩斯地区入院前被诊断为“哮喘”或“COPD”并救护车送到急诊的所有患者进行一项回顾性队列研究。我们将救护车数据和急诊科出院诊断相结合进行研究。
结果：1067位院前医护人员诊断为哮喘的患者中，41%的患者急诊室出院诊断为哮喘，阳性预测值（PPV）为41%（95%可信区间38-44%）。1048位院前诊断为COPD的患者中，57%急诊室出院诊断为COPD (PPV 57%; 95%可信区间 54-60%)。在急诊室患者院前诊断为哮喘或COPD的敏感性分别为66% (95% 可信区间 63-70%) 和39% (95%可信区间 36-41%)。院前报告86%的哮喘患者和55%的COPD患者存在喘息现象。
结论：院前区分哮喘和COPD是困难的。对呼吸困难应用一个临床实践指南将更有利于医护人员对这些患者进行临床处理。
（杨冬 审校）
Prehosp Emerg Care. 2015 Feb 9. [Epub ahead of print]
Paramedic Differentiation of Asthma and COPD in the Prehospital Setting Is Difficult.
Williams TA, Finn J, Fatovich D, Perkins GD, Summers Q, Jacobs I.
ABSTRACT
INTRODUCTION：Separate clinical practice guidelines (CPG) for asthma and chronic obstructive pulmonary disease (COPD) often guide prehospital care. However, having distinct CPGs implies that paramedics can accurately differentiate these conditions. We compared the accuracy of paramedic identification of these two conditions against the emergency department (ED) discharge diagnosis.
METHODS：A retrospective cohort of all patients transported to ED by ambulance in Perth, Western Australia between July 2012 and June 2013; and identified as "asthma" or "COPD" by paramedics. We linked ambulance data to emergency department discharge diagnosis.
RESULTS：Of 1,067 patients identified by paramedics as having asthma, 41% had an ED discharge diagnosis of asthma, i.e., positive predictive value (PPV) = 41% (95% CI 38-44%). Of 1,048 patients recorded as COPD, 57% had an ED discharge diagnosis of COPD (PPV 57%; 95% CI 54-60%). Sensitivity for the paramedic identification of patients diagnosed with asthma or COPD in the ED was 66% for asthma (95% CI 63-70%) and 39% for COPD (95% CI 36-41%). Paramedics reported wheezing in 86% of asthma and 55% of COPD patients.
CONCLUSION：Differentiating between asthma and COPD in the prehospital setting is difficult. A single CPG for respiratory distress would be more useful for the clinical management of these patients by paramedics.
Prehosp Emerg Care. 2015 Feb 9. [Epub ahead of print]
