119 구급대의 병원 전 뇌졸중 선별검사의 타당도 분석: 전향적 관찰연구

Abstract

Purpose: We evaluated the validity of Pre-Hospital stroke screening (PHSS) by 119 ambulance rescuers in Korea. Methods: Patients at least 20 years old with presumed stroke were transported to six emergency medical centers and prospectively enrolled during a 12-month period. A total of 119 ambulance rescuers applied the Cincinnati Pre-Hospital Stroke Scale (CPHSS) and the Los Angeles Pre-Hospital Stroke Screen (LAPHSS). Emergency physicians (EPs) further assessed the patients with CPHSS and LAPHSS. The final diagnoses were divided into stroke and other disease categories through a review of hospital records. The sensitivity and specificity of the two screening tools were analyzed for predicting stroke. The CPHSS and LAPHSS scores from all patients were compared between the 119 ambulance rescuers and EPs. Results: The 119 ambulance rescuers referred 348 suspected stroke patients, of whom 164(47.1%) had their stroke confirmed. For all kinds of stroke, the sensitivity and specificity of the CPHSS were 86.3%[95% confidence interval (CI) 58.6~76.1] and 65.9%(95% CI 57.0~74.0), respectively,and those of the LAPHSS were 70%(95% CI 61.0~78.0) and 67.8%(95% CI 58.6~76.1), respectively. The Kappa value between the 119 ambulance rescuers and EPs was k=0.619(95% CI 0.523~0.715) for the CPHSS and k=0.392(95% CI 0.275~0.510) for the LAPHSS. Conclusion: CPHSS and LAPSS performed by 119 ambulance rescuers had considerable validity in Korea.