Evaluation of a prehospital XXXX protocol.

@entity1 @entity662 @entity1242 @entity1442 @entity741 @entity1167 @entity943
STUDY OBJECTIVES: To evaluate the diagnostic accuracy and outcomes for @entity1 treated by use of a prehospital @entity662 protocol (CPP). DESIGN: Consecutive case series for 1 year (1993) of prehospital nontrauma @entity1442 ( @entity1442 ) cases including hospital outcomes. SETTING: Nonurban two-tiered emergency medical services system. @entity1 : @entity1 treated under the prehospital CPP or with hospital diagnoses of @entity741 ( @entity741 ; ICD-9 between 410 and 414). @entity1 with @entity1167 or @entity943 were excluded. INTERVENTIONS: @entity1 were given, by standing orders, ECG monitoring, i.v. access, and sublingual @entity1242 . Further therapy was guided by on-line medical direction. RESULTS: Of 3,122 @entity1442 nontrauma @entity1 , 620 (20%) were treated with the CPP. All @entity1 underwent ECG monitoring, i.v. access was started in 83%, and 61% received @entity1242 . Only 55% of @entity1 completed the entire CPP; @entity1 who failed to complete the CPP had the same prevalence of @entity741 as those who completed it. When compared with hospital diagnosis of @entity741 , the CPP had a sensitivity of 69% (95% confidence interval [CI], 64% to 74%), a specificity of 87% (95% CI, 86% to 88%), and a positive predictive value of 42%. The positive likelihood ratio of CPP for @entity741 was 5.31, and the negative likelihood ratio was .36. The hospital mortality rate for all @entity1 was 2.2%; for those with @entity741 , it was 1.6%. CONCLUSION: This prehospital @entity1442 CPP had good diagnostic accuracy, but only half of @entity1 completed it, and the hospital mortality rate was low. These data challenge the efficacy of the CPP.
