Agreement between ambulance nurses and physicians in assessing stroke patients

Acta Neurol Scand. 2014 Jan;129(1):49-55. doi: 10.1111/ane.12149. Epub 2013 May 25.

Abstract

Objectives: If an ambulance nurse could bypass the emergency department (ED) and bring suspected stroke patients directly to a CT scanner, time to thrombolysis could be shortened. This study evaluates the level of agreement between ambulance nurses and emergency physicians in assessing the need for a CT scan, and interventions and monitoring beforehand, in patients with suspected stroke and/or a lowered level of consciousness.

Methods: From October 2008 to June 2009, we compared the ambulance nurses' and ED physicians' judgement of 200 patients with stroke symptoms. Both groups answered identical questions on patients' need for a CT scan, and interventions and monitoring beforehand.

Results: There was poor agreement between ambulance nurses and ED physicians in judging the need for a CT scan: κ = 0.22 (95% confidence interval (CI), 0.06-0.37). The nurses' ability to select the same patients as the physician for a CT scan had a sensitivity of 84% (95% CI, 77-89) and a specificity of 37% (95% CI, 23-53). Agreement concerning the need for interventions and monitoring was also low: κ = 0.32 (95% CI, 0.18-0.47). In 18% of cases, the nurses considered interventions before a CT scan unnecessary when the physicians' deemed them necessary.

Conclusions: Additional tools to support ambulance nurses decisions appear to be required before suspected stroke patients can be taken directly to a CT scanner.

Keywords: acute stroke therapy; emergency; ischemic stroke; prehospital care; protocols; stroke teams; thrombolysis.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Ambulances
  • Brain Diseases / diagnosis
  • Consciousness Disorders / etiology
  • Consensus*
  • Diagnosis, Differential
  • Emergency Treatment
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Nurses*
  • Nursing Assessment*
  • Physicians*
  • Sensitivity and Specificity
  • Stroke / diagnosis*
  • Stroke / diagnostic imaging
  • Stroke / drug therapy
  • Symptom Assessment
  • Time Factors
  • Tomography, X-Ray Computed* / statistics & numerical data

Substances

  • Fibrinolytic Agents