Comparing the diagnostic concordance of tele-EMS and on-site-EMS physicians in emergency medical services: a retrospective cohort study

Lina T M Quadflieg,Jörg C Brokmann,Hanna Schröder,Rolf Rossaint,Anja Sommer,Marc Felzen,Ann-Katrin Brockert,Stefan K Beckers,Sebastian Bergrath

doi:10.1038/s41598-020-75149-8

Abstract

In 2014, a telemedicine system was established in 24-h routine use in the emergency medical service (EMS) of the city of Aachen. This study tested whether the diagnostic concordance of the tele-EMS physician reaches the same diagnostic concordance as the on-site-EMS physician. The initial prehospital diagnoses were compared to the final hospital diagnoses. Data were recorded retrospectively from the physicians’ protocols as well as from the hospital administration system and compared. Also, all diagnostic misconcordance were analysed and reviewed in terms of logical content by two experts. There were no significant differences between the groups in terms of demographic data, such as age and gender, as well as regarding the hospital length of stay and mortality. There was no significant difference between the diagnostic concordance of the systems, except the diagnosis “epileptic seizure”. Instead, in these cases, “stroke” was the most frequently chosen diagnosis. The diagnostic misconcordance “stroke” is not associated with any risks to patients’ safety. Reasons for diagnostic misconcordance could be the short contact time to the patient during the teleconsultation, the lack of personal examination of the patient by the tele-EMS physician, and reversible symptoms that can mask the correct diagnosis.

Highlights

In 2014, a telemedicine system was established in 24-h routine use in the emergency medical service (EMS) of the city of Aachen
The prehospital diagnoses of 584 patients treated by the tele-EMS physician and 634 patients treated by the on-site-EMS physician were analysed
After comparing the diagnoses using the ICD-10-system and after the double expert review, which compared the diagnoses content-wise and logically, there was no significant difference between the accuracy of the correct diagnoses in general (p = 0.0193)

Summary

Introduction

In 2014, a telemedicine system was established in 24-h routine use in the emergency medical service (EMS) of the city of Aachen. There was no significant difference between the diagnostic concordance of the systems, except the diagnosis “epileptic seizure”. Reasons for diagnostic misconcordance could be the short contact time to the patient during the teleconsultation, the lack of personal examination of the patient by the tele-EMS physician, and reversible symptoms that can mask the correct diagnosis. During the years after implementation, the number of telemedicine consultations for prehospital emergency patients increased. The tele-EMS physician can offer support for paramedics especially regarding diagnosis. It is important to know whether a distant tele-EMS physician can determine the correct diagnosis from the given information by the paramedics. As there are no predefined diagnoses for both, on-site-EMS and tele-EMS-physician, the tele-EMS physician needs to determine the correct diagnosis based on the information provided by the paramedics using clinical findings. There are hardly any evaluations of the diagnostic concordance of on-site-EMS physicians and none of tele-EMS p hysicians[10]

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Conclusion