Paramedic differentiation of asthma and COPD in the prehospital setting is difficult

Williams, Teresa A., Finn, Judith, Fatovich, Daniel, Perkins, Gavin D., Summers, Quentin and Jacobs, Ian (2015) Paramedic differentiation of asthma and COPD in the prehospital setting is difficult. Prehospital Emergency Care, 4 2015: 535-543. doi:10.3109/10903127.2014.995841


Author Williams, Teresa A.
Finn, Judith
Fatovich, Daniel
Perkins, Gavin D.
Summers, Quentin
Jacobs, Ian
Title Paramedic differentiation of asthma and COPD in the prehospital setting is difficult
Journal name Prehospital Emergency Care   Check publisher's open access policy
ISSN 1090-3127
1545-0066
Publication date 2015
Year available 2015
Sub-type Article (original research)
DOI 10.3109/10903127.2014.995841
Open Access Status Not Open Access
Volume 4
Issue 2015
Start page 535
End page 543
Total pages 9
Place of publication Philadelphia, PA United States
Publisher Taylor and Francis
Collection year 2016
Language eng
Formatted 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
Keyword Asthma
Copd
Paramedic
Ambulance
Clinical practice guidelines
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
School of Nursing, Midwifery and Social Work Publications
 
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Created: Mon, 19 Oct 2015, 13:13:48 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work