Evaluation der modifizierten strukturierten Notrufabfrage bei akutem Thoraxschmerz im Rahmen des Projekts „Telemedizin im Rettungsdienst in Mittelhessen“

Background The German emergency medical services face an increasing physician shortage while the demand for time-critical emergency medical care is constantly rising. In order to guarantee a safe and quick distribution of emergency physicians to criti-cal ill patients, medically unnecessary missions must be reduced to prevent a lack of emergency care. As a first approach, a modified dispatch algorithm for acute chest pain has been put in place in the emergency medical services of the central Hesse region. In a second step, paramedic-staffed ambulances with phy-sician-based telemedical support could be dispatched to stable cases of patients with acute coronary syndrome, if the algorithm proves to be safe in the distinction between stable and critical cases. The goal of this study is to evaluate whether the modified dispatch algorithm for acute chest pain could predict, if the patient would be in a stable or critical condition in prehospital care. Method Between January and August 2021, data of 595 cases of patients with acute cor-onary syndrome has been collected. These cases have been categorized by the medical dispatch centre with the “modified dispatch algorithm for acute chest pain” into the groups ACS 1=stable condition and ACS 2=critical condition. Both groups have been analysed regarding age, sex and average vital parameters. The prehospital condition was evaluated by a score that has been developed for this study, with a scale from 0 to 20 and a cut-off at ≥3 for critical condition. Sen-sitivity and specificity of the modified dispatch algorithm have been calculated in relation to the score. Results Out of 635 cases of dispatched acute coronary syndromes, 595 data records have been analysed (93,7%). The group ACS 1 = stable was significantly smaller (n=101) than the group ACS 2 = critical (n=494). Both groups showed no statis-tically significant differences regarding age, sex or average vital parameters. In 88% of the recorded cases, critical ill patients were recognized as such, while the specificity of the dispatch algorithm was only at 18.7%. Discussion & Conclusion This study evaluated for the first time a modified dispatch algorithm for acute chest pain towards the precision in predicting a critical condition in prehospital care. With 17% of the missions that were safely assigned as stable, almost every fifth emergency physician mission to these kinds of cases could be avoided in favour of more critical missions after the full implementation of a telemedical sys-tem in prehospital emergency medicine. The sensitivity of 88% and specificity of 18,7% verify a dispatch algorithm that was designed for the highest possible pa-tient safety instead of diagnostic accuracy. The relatively small patient collective and the exclusive application in only one administrative district are limiting for the meaningfulness of this study. In order to confirm the results, further studies with a larger study collective and the inclusion of several districts with different demo-graphic structures are necessary. So far, there have only been few evaluations of standardized dispatch algorithms in the literature, mostly because they have not yet been used comprehensively in german dispatch centres. Standardized dispatch algorithms that allow differentiation of the medical necessity of emer-gency medical services have not yet been fully evaluated. The results of this work are a first contribution to the realignment of rescue service processes and a necessary restructuring in the distribution of scarce emergency staff resources. Further studies must show whether this approach can also be transferred to other administrative districts and other emergency cases. It also remains to be seen to what extent the specificity and thus the effectiveness of such a dispatch algorithm can be increased without endangering patient safety.