Experiences from a cluster-randomized trial (ParaNASPP) exploring triage and diagnostic accuracy in paramedic-suspected stroke: a qualitative interview study

Timely prehospital stroke recognition was explored in the Paramedic Norwegian Acute Stroke Prehospital Project (ParaNASPP) by implementation of stroke education for paramedics and use of the National Institutes of Health Stroke Scale (NIHSS) through a mobile application. The study tested triage and...

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Veröffentlicht in:European journal of neurology 2024-05, Vol.31 (5), p.e16252
Hauptverfasser: Guterud, Mona, Hardeland, Camilla, Bugge, Helge Fagerheim, Sandset, Else Charlotte, Svendsen, Edel Jannecke, Hov, Maren Ranhoff
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container_issue 5
container_start_page e16252
container_title European journal of neurology
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creator Guterud, Mona
Hardeland, Camilla
Bugge, Helge Fagerheim
Sandset, Else Charlotte
Svendsen, Edel Jannecke
Hov, Maren Ranhoff
description Timely prehospital stroke recognition was explored in the Paramedic Norwegian Acute Stroke Prehospital Project (ParaNASPP) by implementation of stroke education for paramedics and use of the National Institutes of Health Stroke Scale (NIHSS) through a mobile application. The study tested triage and facilitated communication between paramedics and stroke physicians. To complement the quantitative results of the clinical trial, a qualitative approach was used to identify factors that influence triage decisions and diagnostic accuracy in prehospital stroke recognition experienced by paramedics and stroke physicians. Semi-structured qualitative individual interviews were performed following an interview guide. Informants were recruited from the enrolled paramedics and stroke physicians who participated in the ParaNASPP trial from Oslo University Hospital. Interviews were audio recorded, transcribed verbatim and approached inductively using the principles of thematic analysis. Fourteen interviews were conducted, with seven paramedics and seven stroke physicians. Across both groups two overarching themes were identified related to triage decisions and diagnostic accuracy in prehospital stroke recognition: prehospital NIHSS reliably improves clinical assessment and communication quality; overtriage is widely accepted whilst undertriage is not. Paramedics and stroke physicians described how prehospital NIHSS improved communication quality and reliably improved prehospital clinical assessment. The qualitative results support a rationale of an application algorithm to decide which NIHSS items should prompt immediate prenotification rather than a complete NIHSS as default.
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source MEDLINE; Wiley Journals; Wiley Online Library (Open Access Collection); PubMed Central
subjects Accuracy
Algorithms
Applications programs
Communication
Decisions
Emergency Medical Services - methods
Humans
Interviews
Mobile computing
Paramedics
Physicians
Qualitative Research
Quality assessment
Recognition
Stroke
Stroke - diagnosis
Triage - methods
United States
title Experiences from a cluster-randomized trial (ParaNASPP) exploring triage and diagnostic accuracy in paramedic-suspected stroke: a qualitative interview study
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