Background and Purpose‹ Emergency medical dispatchers play an important rolein optimizing stroke care if they are able to accurately identify callsregarding acute cerebrovascular disease. This study was undertaken to assessthe diagnostic accuracy of the current national protocol guiding dispatcherquestioning of 911 callers to identify stroke (QA Guide version 11.1 of theNational Academy Medical Priority Dispatch System).
Methods‹ We identified all Los Angeles Fire Department paramedic transportsof patients to University of California Los Angeles Medical Center duringthe 12-month period from January to December 2005 in a prospectivelymaintained database. Dispatcher-assigned Medical Priority Dispatch Systemcodes for each of these patient transports were abstracted from theparamedic run sheets and compared to final hospital discharge diagnosis.Results‹ Among 3474 transported patients, 96 (2.8%) had a final diagnosis ofstroke or transient ischemic attack. Dispatchers assigned a code ofpotential stroke to 44.8% of patients with a final discharge diagnosis ofstroke or TIA. Dispatcher identification of stroke showed a sensitivity of0.41, specificity of 0.96, positive predictive value of 0.45, and negativepredictive value of 0.95. Conclusions‹ Dispatcher recognition of stroke calls using the widelyemployed Medical Priority Dispatch System algorithm is suboptimal, withfailure to identify more than half of stroke patients as likely stroke.Revisions to the current national dispatcher structured interview andsymptom identification algorithm for stroke may facilitate more accuraterecognition of stroke by emergency medical dispatchers.Stroke. 2009;40:2027- 2030 Stephan Gascon via BlackBerry
