title: Paramedic diagnostic accuracy for patients complaining of chest pain or shortness of breath.
abstract: BACKGROUND
  A multitude of life-threatening and nonlife-threatening processes cause chest pain and shortness of breath. Prehospital therapy for these patients may be lifesaving and includes pharmacologic interventions, as well as invasive procedures. Appropriate therapy depends on the diagnostic skills of the paramedic.
  
  
  OBJECTIVE
  This study was undertaken to determine the accuracy of the paramedic diagnosis in patients transported with a chief complaint of pain or shortness of breath.
  
  
  METHODS
  Multihospital, one large municipal hospital, one community hospital.
  
  
  METHODS
  Prospective, cross-sectional study. Paramedics evaluated the patient and then completed a standard form indicating the diagnosis. The paramedic's and final emergency physician's diagnoses were compared to assess the accuracy of the paramedic diagnosis.
  
  
  METHODS
  All patients who complained of chest pain or shortness of breath, transported to the study centers by the city of Denver paramedics, were eligible for the study. Ninety-nine of the 102 patients enrolled had complete records for analysis and were entered into the study.
  
  
  RESULTS
  Diagnostic concordance data were analyzed by organ system (e.g., cardiac, pulmonary, etc.) and for specific diagnoses using the kappa statistic and McNemar's chi-square analysis for discordant pairs. Using the kappa statistic, there was statistically significant concordance between the paramedic and emergency-physician diagnosis for cardiac (p = 0.0001; kappa value = 0.54) and pulmonary organ systems (p = 0.0001; kappa value = 0.61). Overall, for organ system diagnosis, the paramedics had an 82% accuracy (p = 0.05) rating. For specific cardiac and pulmonary diagnosis, paramedics had good concordance with emergency physicians.
  
  
  CONCLUSIONS
  Overall, paramedics have excellent diagnostic agreement with emergency-physician diagnosis by organ system. They retained good agreement on specific cardiac diagnoses and pulmonary diagnosis.
authors.affiliation: Department of Emergency Medicine, Cook County Hospital, Chicago, Illinois, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Schaider
authors.forename: J C
authors.initials: JC
authors.lastname: Riccio
authors.forename: R J
authors.initials: RJ
authors.lastname: Rydman
authors.forename: P T
authors.initials: PT
authors.lastname: Pons
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000175:diagnosis* / Q000209:etiology; D016009:Chi-Square Distribution; D002983:Clinical Competence / Q000592:standards*; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000175:diagnosis* / Q000209:etiology; D004634:Emergency Medical Technicians / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity