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논문 기본 정보

자료유형
학술저널
저자정보
Han Sol (Department of Emergency Medicine Jeju National University Hospital Jeju Korea) Song Sung Wook (Department of Emergency Medicine Jeju National University College of Medicine Jeju Korea.) Hong Hansol (Department of Emergency Medicine Jeju National University Hospital Jeju Korea) 김우정 (제주대학교) 강영준 (제주대학교) Park Chang Bae (Department of Emergency Medicine Jeju National University Hospital Jeju Korea) Kang Jeong Ho (Jeju National University College of Medicine and Graduate School of Medicine) Bu Ji Hwan (Department of Emergency Medicine Jeju National University Hospital Jeju Korea) 이성근 (제주대학교) Ko Seo Young (Department of Emergency Medicine Jeju National University Hospital Jeju Korea) 이수훈 (제주대학교병원) Kang Chul-Hoo (Department of Neurology Jeju National University Hospital Jeju National University School of Medicine Jeju Korea.)
저널정보
대한응급의학회 Clinical and Experimental Emergency Medicine Clinical and Experimental Emergency Medicine Vol.10 No.2
발행연도
2023.6
수록면
213 - 223 (11page)
DOI
10.15441/ceem.22.372

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Objective: This study investigated the hospital diagnoses and characteristics of uncooperative prehospital patients suspected of acute stroke who could not undergo a prehospital stroke screening test (PHSST). Methods: This retrospective observational study was conducted at a single academic hospital with a regional stroke center. We analyzed three scenario-based prehospital stroke screening performances using the final hospital diagnoses: (1) a conservative approach only in patients who underwent the PHSST, (2) a real-world approach that considered all uncooperative patients as screening positive, and (3) a contrapositive approach that all uncooperative patients were considered as negative. Results: Of the 2,836 emergency medical services (EMS)-transported adult patients who met the prehospital criteria for suspicion of acute stroke, 486 (17.1%) were uncooperative, and 570 (20.1%) had a confirmed final diagnosis of acute stroke. The diagnosis in the uncooperative group did not differ from that in the cooperative group (22.0% vs. 19.7%, P=0.246). The diagnostic performances of the PHSST in the conservative approach were as follows: 79.5% sensitivity (95% confidence interval [CI], 75.5%–83.1%), 90.2% specificity (95% CI, 88.8%–91.6%), and 0.849 area under the receiver operating characteristic curve (AUC; 95% CI, 0.829–0.868). The sensitivity and specificity were 83.3% (95% CI, 80.0%–86.3%) and 75.2% (95% CI, 73.3%–76.9%), respectively, in the real-world approach and 64.6% (95% CI, 60.5%–68.5%) and 91.9% (95% CI, 90.7%–93.0%), respectively, in the contrapositive approach. No significant difference was evident in the AUC between the real-world approach and the contrapositive approach (0.792 [95% CI, 0.775–0.810] vs. 0.782 [95% CI, 0.762–0.803], P>0.05). Conclusion: We found overestimation (false positive) and underestimation (false negative) in the uncooperative group depending on the scenario-based EMS stroke screening policy for uncooperative prehospital patients suspected of acute stroke.

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