This Article Full Text Full Text (PDF) All Versions of this Article: 40/6/2027    most recent STROKEAHA.108.545574v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Buck, B. H. Articles by Saver, J. L. Search for Related Content PubMed PubMed Citation Articles by Buck, B. H. Articles by Saver, J. L. Pubmed/NCBI databases Medline Plus Health Information Stroke Related Collections Health policy and outcome research Acute Cerebral Infarction Acute Stroke Syndromes Emergency treatment of Stroke Transient Ischemic Attacks

(Stroke. 2009;40:2027.)
© 2009 American Heart Association, Inc.

Original Contributions

Dispatcher Recognition of Stroke Using the National Academy Medical Priority Dispatch System

Brian H. Buck, MD, FRCPC; Sidney Starkman, MD; Marc Eckstein, MD, MPH; Chelsea S. Kidwell, MD; Jill Haines, RN; Rainy Huang, RN; Daniel Colby, BSc Jeffrey L. Saver, MD

From University of California at Los Angeles Stroke Center (B.H.B., S.S., J.H., R.H., D.C., J.L.S.), Department of Neurology, UCLA Medical Center, Los Angeles, Calif; University of Alberta (B.H.B.), Division of Neurology Department of Medicine, Edmonton, Canada; University of California at Los Angeles Department of Emergency Medicine (S.S.), UCLA Medical Center, Los Angeles, Calif; Keck School of Medicine of the University of Southern California (M.E.), Los Angeles, Calif; Los Angeles Fire Department (M.E.), Los Angeles, Calif; Georgetown University (C.S.K.), Department of Neurology, Washington, DC.

Correspondence to Brian H. Buck, Division of Neurology, Department of Medicine, University of Alberta, 5223-1100 Youville Drive West NW, Edmonton, Alberta T6L 5X8. E-mail brianhbuck{at}gmail.com

Background and Purpose— Emergency medical dispatchers play an important role in optimizing stroke care if they are able to accurately identify calls regarding acute cerebrovascular disease. This study was undertaken to assess the diagnostic accuracy of the current national protocol guiding dispatcher questioning of 911 callers to identify stroke (QA Guide version 11.1 of the National Academy Medical Priority Dispatch System).

Methods— We identified all Los Angeles Fire Department paramedic transports of patients to University of California Los Angeles Medical Center during the 12-month period from January to December 2005 in a prospectively maintained database. Dispatcher-assigned Medical Priority Dispatch System codes for each of these patient transports were abstracted from the paramedic run sheets and compared to final hospital discharge diagnosis.

Results— Among 3474 transported patients, 96 (2.8%) had a final diagnosis of stroke or transient ischemic attack. Dispatchers assigned a code of potential stroke to 44.8% of patients with a final discharge diagnosis of stroke or TIA. Dispatcher identification of stroke showed a sensitivity of 0.41, specificity of 0.96, positive predictive value of 0.45, and negative predictive value of 0.95.

Conclusions— Dispatcher recognition of stroke calls using the widely employed Medical Priority Dispatch System algorithm is suboptimal, with failure to identify more than half of stroke patients as likely stroke. Revisions to the current national dispatcher structured interview and symptom identification algorithm for stroke may facilitate more accurate recognition of stroke by emergency medical dispatchers.

Key Words: emergency medical services • prehospital care • stroke

This article has been cited by other articles:

				J. J. Clawson, C. H.O. Olola, and G. Scott Compliance With and Use of Up-to-Date National Academies of Medical Dispatch Medical Priority Dispatch System Protocols in Dispatch Practice and Research Studies Must Be a Requirement Stroke, October 1, 2009; 40(10): e591 - e592. [Full Text] [PDF]

				B. H. Buck, S. Starkman, M. Eckstein, C. S. Kidwell, and J. L. Saver Response to Letter by Clawson et al Stroke, October 1, 2009; 40(10): e593 - e593. [Full Text] [PDF]