Paramedic identification of APO

Paramedic Identification of Acute Pulmonary Oedema in a Metropolitan Ambulance Service

Prehospital Emergency Care. July-September 2013, Vol. 17, No. 3 , Pages 339-347

© Gary Wilson/ Pre-hospital Research Forum

© Gary Wilson/ Pre-hospital Research Forum

Acute pulmonary oedema (APO) is a common cause of acute dyspnea. In the prehospital setting, it is often difficult to differentiate APE from other causes of shortness of breath (SOB). Radiography and echocardiography aid in the identification of APO but are often not available. There is little information on how accurately ambulance paramedics identify patients with APO.

Objectives. This study aimed to 1) describe the prehospital clinical presentation and management of patients with a clinical diagnosis of APO and 2) compare the accuracy of coding of APO by paramedics against the emergency department (ED) medical discharge diagnosis.

Methods. This study included a retrospective cohort of all patients who had episodes identified as APO by ambulance paramedics and were transported to a metropolitan hospital ED in 2011. Two databases were used: an ambulance database and the Emergency Department Information System. The ED medical discharge diagnosis (using International Statistical Classification of Diseases and Related Problems, 10th Revision, Australian Modification [ICD-10-AM] codes) was used as the comparator with paramedic-assigned problem codes for APE. The outcomes for the study were the positive predictive value, i.e., the proportion of patients identified as having APE in the ambulance database who also had an ED discharge diagnosis of APO, and the sensitivity of paramedic identification of APO, i.e., the proportion of patients with an ED discharge diagnosis of APO that were correctly identified as APO by the ambulance paramedics.

Results. Four hundred ninety-five patients were transported to an ED with APO identified by the paramedics as the primary problem code. Shortness of breath, crepitations, high systolic blood pressure, and chest pain were the most common presenting signs and symptoms. Pink frothy sputum was rare (3% of patient episodes of APO). One hundred eighty-six patients received an ED discharge diagnosis of APO, i.e., a positive predictive value of 41%. Of 631 ED presentations with APO, paramedics identified 186, i.e., a sensitivity of 29%.

Conclusion. Acute pulmonary oedema is difficult to identify in the prehospital setting because of the variability in the signs and symptoms associated with this condition. Improved identification of OPE is essential in the initiation of appropriate and timely care. Ambulance paramedics need to be aware of such variability when considering patients who may be suffering from OPE.

http://informahealthcare.com/doi/abs/10.3109/10903127.2013.773114

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